Hepatitis B and C in the Liver Transplant Recipient

Hugo R. Rosen; Paul Martin

doi:10.1055/s-2000-13156

Seminars in Liver Disease, Table of Contents

Semin Liver Dis 2000; 20(4): 465-480
DOI: 10.1055/s-2000-13156

Hepatitis B and C in the Liver Transplant Recipient

Hugo R. Rosen¹ , Paul Martin²

¹Division of Gastroenterology/Hepatology and Liver Transplantation Program, Portland Veterans Administration, and Oregon Health Sciences University, Portland, Oregon
²Division of Digestive Diseases and Dumont-UCLA Transplant Program, Center for Health Sciences, University of California at Los Angeles; Los Angeles, California

Abstract

ABSTRACT

Liver disease related to chronic viral hepatitis is the leading indication for orthotopic liver transplantation (OLT) worldwide. The evolution of our understanding of hepatitis B and C infection in the OLT recipient has been rapid in the last decade. The spontaneous risk for viral recurrence after transplantation is high but has been effectively decreased in hepatitis B infected recipients with the use of HBIG and lamivudine with dramatic improvements in patient and graft survivals. HCV recurrence as defined by histologic injury is almost universal although graft or patient outcomes for the first decade after OLT do not appear to be limited by HCV infection for most patients. However, individual patients do suffer severe graft injury and even graft loss due to recurrent HCV. With longer follow up into the second decade, the prevalence of HCV-related graft failure is likely to increase. In addition, the role of different immunosuppressive protocols on disease recurrence requires further study. Thus, although hepatitis B recurrence has been effectively contained by use of HBIG with or without lamivudine, the more intractable problem of managing recurrent HCV has as yet no obvious solutions. Optimal antiviral strategies for hepatitis C post-OLT have yet to be identified.

KEYWORD

hepatitis B - hepatitis C - viral recurrence

Full Text

References

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