Treatment of liver transplant recipients who have chronic hepatitis C virus infection.

Chronic hepatitis C virus infection is the most common cause of chronic liver disease and indication for liver transplant in Western countries. Viral infection may recur after transplant in most patients. The diagnosis of histologic recurrence of hepatitis C virus infection after liver transplant may be difficult and may be confused with acute cellular graft rejection. Characteristics of the recipient, donor, virus, and transplant may be associated with disease progression. Treatment of hepatitis C virus infection has a positive effect on the outcome of liver transplant. There are 3 approaches used to minimize recurrent hepatitis C virus infection after liver transplant: antiviral therapy before transplant, antiviral preventive and preemptive treatment after transplant, and treatment of established reinfection. Protease inhibitors are being evaluated in patients who have severe hepatitis C virus recurrence after liver transplant. Liver graft survival is less frequent after revision transplant. Several new drugs currently are being evaluated in clinical trials for treatment of hepatitis C virus infection.