The recurrence of hepatitis C virus after liver transplantation

Abstract

An early HCV recurrence can be expected in case of an older donor, with a marginal or fatty liver graft transplanted with a higher transfusion need and having an acute rejection treated with steroid bolus in the postoperative period. The protocol of the postoperative antiviral treatment differs from the average: the so-called "stop-rule" cannot be applied, since less then 10% of the recipients are expected to turn to HCV-PCR-negative due to the immunosuppression. The combined interferon + ribavirin treatment is maintained in spite of RNA-positive state, further, a second or third course of treatment might also be applied. The prolonged and--in case if necessary--repeated antiviral treatment prevents fibrosis, and therefore rate of retransplantation need. The better is the general state of the patient the results of a secondary liver transplantation are better as well. MELD-score can help to set the exact timing for a re-OLT.

Treatment of recurrent hepatitis C virus infection in patients after liver transplantation

“…Survival rates at 1, 3 and 5 years in patents taking tacrolimus or tacrolimus and a steroid together were 92%, 92%, 73% and 78%, 61%, 51% respectively [22]. Data in Hungary also confirm that acute rejection and subsequent bolus steroid therapy favours early HCV recurrence [2]. No beneficial effect of antibodies against interleukin-2 on HCV infection could be confirmed definitely [23].…”

“…Results of the liver transplantation centre in Hungary (Department of Transplantation and Surgery, Semmelweis University) show that early recurrence of HCV infection is facilitated by marginal liver grafts originating from elderly donors, transplantation in patients with higher requirement for blood transfusion, and patients with significantly advanced hepatic cirrhosis (Child score > 11) [2]. More severe baseline histology and significant elevation of liver enzyme values are associated with a shortened duration of graft and patient survival [14] (Fig.…”

“…Similarly to the data of literature, 37.6% of liver transplantations performed in an organised form in Hungary since 1995 were due to HCV cirrhosis. Of the 295 orthotopic liver transplantations (OLT) performed between 1995 and 2007, end-stage HCV cirrhosis was the indication in 111 patients [2]. Recurrence of HCV infection is common after liver transplantation and it may significantly decrease graft and patient survival [3].…”

Hepatitis C virus recurrence after liver transplantation in Hungary. Trends over the past 10 years

“…A vizsgált betegek és az alkalmazott módszer tekintetében utalunk korábbi közleményünkre [9]. Célunk az elmúlt tíz évben (2003-2012) és az 1995-2007-ig terjedő időszakban HCV-cirrhosis miatt vég-zett májtranszplantációk eredményeinek összehasonlí-tása volt.…”

“…A hazai májátültetési program kezdete, 1995 óta több mint 200 beteg került transzplantációra HCV-cirrhosis miatt. Korábbi közleményben az 1995 és 2007 között C-vírus okozta májcirrhosis miatt transzplantált betegek utánkövetéséről számoltunk be [9]. Jelenlegi munkánk az eredeti közlés tematikáját alapul véve, azt kiterjesztve, az elmúlt tíz évben, 2003 és 2012 között végzett májtranszplantációk kimenetelét vizsgálja HCV-s betegek körében.…”