[Hepatitis C and liver transplantation: fibrosis progression and treatment. Or how to improve management].

Abstract

Hepatitis C virus-related end-stage liver disease, alone or in combination with alcohol, has become the leading indication for liver transplantation in most transplant programs accounting for approximately half of transplants performed in European centers. Hepatitis C virus infection recurs virtually in every post-transplant patient. The natural history of hepatitis C after liver transplantation is variable. Progression of chronic hepatitis C virus is more aggressive after liver transplantation with a cumulative probability of developing graft cirrhosis estimated to reach 30% at 5 years. Approximately 10% of the patients with recurrent disease will die or require re-transplantation within 5 years post-transplantation. Several factors, including those related to the virus, the host, the environment and the donor, are probably implicated in the outcome. The immune status represents the main significant variable in influencing disease severity in hepatitis C virus-infected patients; with higher HCV viral load and the significant association described between the degree of immunosuppression and disease severity. Interventions to prevent, improve, or halt the recurrence of hepatitis C virus infection have been evaluated by multiple small studies worldwide with similar overall rates of virological clearance of approximately 9-30%. Current consensus recommends combination therapy with pegylated interferon and ribavirin for those patients with histological recurrence of hepatitis C virus infection and fibrosis. Therapy is adjusted to tolerance and rescued with granulocyte colony-stimulating factor and erythropoietin for bone marrow suppression. In this article we present a comprehensive review of post-transplant hepatitis C virus infection; in particular fibrosis progression and the major challenges according to treatment.

• Authors: Tarik Asselah, Hamza Boudjema, Claire Francoz, Rodolphe Sobesky, Dominique Valla, Jacques Belghiti, Patrick Marcellin, François Durand
• Journal: Gastroenterologie clinique et biologique (Gastroenterol Clin Biol) Vol. 30 Issue 11 Pg. 1281-95 (Nov 2006) ISSN: 0399-8320 [Print] France
• Vernacular Title: Hépatite C et transplantation hépatique. Histoire naturelle et traitement ou comment améliorer la prise en charge?
• PMID: 17185970 (Publication Type: English Abstract, Journal Article, Review)

Chemical References

• Antiviral Agents
• Ribavirin
• Interferons

Topics

• Antiviral Agents (adverse effects, therapeutic use)
• Disease Progression
• Drug Therapy, Combination
• Graft Rejection (therapy)
• Hepatitis C (diagnosis, therapy)
• Hepatitis C, Chronic (therapy)
• Humans
• Interferons (adverse effects, therapeutic use)
• Liver Cirrhosis (therapy)
• Liver Transplantation
• Postoperative Complications (therapy)
• Ribavirin (adverse effects, therapeutic use)
• Secondary Prevention
• Treatment Outcome