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Ciria R, Pleguezuelo M, Khorsandi SE, et al. Strategies to reduce hepatitis C virus recurrence after liver transplantation. World J Hepatol. 2013;5(5):237-50doi: 10.4254/wjh.v5.i5.237.
Ciria, R., Pleguezuelo, M., Khorsandi, S. E., Davila, D., Suddle, A., Vilca-Melendez, H., Rufian, S., de la Mata, M., Briceño, J., Cillero, P. L., & Heaton, N. (2013). Strategies to reduce hepatitis C virus recurrence after liver transplantation. World journal of hepatology, 5(5), 237-50. https://doi.org/10.4254/wjh.v5.i5.237
Ciria, Ruben, et al. "Strategies to reduce hepatitis C virus recurrence after liver transplantation." World journal of hepatology vol. 5,5 (2013): 237-50. doi: https://doi.org/10.4254/wjh.v5.i5.237
Ciria R, Pleguezuelo M, Khorsandi SE, Davila D, Suddle A, Vilca-Melendez H, Rufian S, de la Mata M, Briceño J, Cillero PL, Heaton N. Strategies to reduce hepatitis C virus recurrence after liver transplantation. World J Hepatol. 2013 May 27;5(5):237-50. doi: 10.4254/wjh.v5.i5.237. PMID: 23717735; PMCID: PMC3664282.
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World J Hepatol. 2013 May 27;5(5):237-50. doi: 10.4254/wjh.v5.i5.237.

Strategies to reduce hepatitis C virus recurrence after liver transplantation.

World journal of hepatology

Ruben Ciria, María Pleguezuelo, Shirin Elizabeth Khorsandi, Diego Davila, Abid Suddle, Hector Vilca-Melendez, Sebastian Rufian, Manuel de la Mata, Javier Briceño, Pedro López Cillero, Nigel Heaton

Affiliations

  1. Ruben Ciria, Shirin Elizabeth Khorsandi, Diego Davila, Abid Suddle, Hector Vilca-Melendez, Nigel Heaton, Institute of Liver Studies, King's College Hospital, London SE5 9RS, United Kingdom.

PMID: 23717735 PMCID: PMC3664282 DOI: 10.4254/wjh.v5.i5.237

Abstract

Hepatitis C virus (HCV) is a major health problem that leads to chronic hepatitis, cirrhosis and hepatocellular carcinoma, being the most frequent indication for liver transplantation in several countries. Unfortunately, HCV re-infects the liver graft almost invariably following reperfusion, with an accelerated history of recurrence, leading to 10%-30% of patients progressing to cirrhosis within 5 years of transplantation. In this sense, some groups have even advocated for not re-transplanting this patients, as lower patient and graft outcomes have been reported. However, the management of HCV recurrence is being optimized and several strategies to reduce post-transplant recurrence could improve outcomes, decrease the rate of re-transplantation and optimize the use of available grafts. Three moments may be the focus of potential actions in order to decrease the impact of viral recurrence: the pre-transplant moment, the transplant environment and the post-transplant management. In the pre-transplant setting, it is not well established if reducing the pre transplant viral load affects the risk for HCV progression after transplant. Obviously, antiviral treatment can render the patient HCV RNA negative post transplant but the long-term benefit has not yet been fully established to justify the cost and clinical risk. In the transplant moment, factors as donor age, cold ischemia time, graft steatosis and ischemia/reperfusion injury may lead to a higher and more aggressive viral recurrence. After the transplant, discussion about immunosuppression and the moment to start the treatment (prophylactic, pre-emptive or once-confirmed) together with new antiviral drugs are of interest. This review aims to help clinicians have a global overview of post-transplant HCV recurrence and strategies to reduce its impact on our patients.

Keywords: Hepatitis C virus; Liver; Outcomes; Recurrence; Transplantation

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