Since the introduction of
hepatitis B immunoglobulin and
nucleoside/
nucleotide antivirals in the 1990's, outcomes of LT for hepatitis B virus (HBV)-related
liver disease, regardless of whether for decompensated
cirrhosis,
hepatocellular carcinoma satisfying Milan criteria or
fulminant hepatic failure (FHF), have been favorable with results comparable if not better to other
liver transplant recipients. Unfortunately the same optimism does not hold true for
hepatitis C which differs from post- transplant
hepatitis B in many ways, most striking of which are the limited options for treatment of recurrent
hepatitis C (HCV). As time has passed, the initial enthusiasm for
liver transplantation for HCV has waned as the original excellent five year survival rates have now translated into disappointing medium- and long-term survival data.
Cirrhosis can also develop in between 10-25% of patients by five years post-transplant which in turn has led to recurrent HCV-related
cirrhosis emerging as an important yet controversial indication for retransplantation. A variety of diseases can cause FHF with
drug-related hepatotoxicity, particularly from
acetaminophen accounting for 50-60% of cases in United Kingdom and the United States while viral
hepatitis appears to be declining as a cause. Although FHF is a relatively
rare disease affecting approximately 2000 patients per year in the United States, it is associated with high morbidity and mortality without
transplantation yet only 25% of patients in the United States undergo
liver transplantation. This review article will discuss
liver transplantation for HBV and HCV and will conclude with reviewing the etiology, epidemiology and management of FHF.