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World J Gastroenterol. Apr 7, 2014; 20(13): 3391-3400
Published online Apr 7, 2014. doi: 10.3748/wjg.v20.i13.3391
Challenges of recurrent hepatitis C in the liver transplant patient
Renumathy Dhanasekaran, Roberto J Firpi
Renumathy Dhanasekaran, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55901, United States
Roberto J Firpi, Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL 32610, United States
Author contributions: Dhanasekaran R wrote the manuscript; Firpi RJ conceptualized the paper, edited the manuscript and supervisor.
Correspondence to: Roberto J Firpi, MD, MS, Associate Professor, Division of Gastroenterology, Hepatology and Nutrition, University of Florida, 1600 SW Archer Rd, MSB M440, Gainesville, FL 32610, United States. roberto.firpi@medicine.ufl.edu
Telephone: +1-352-2739500 Fax: +1-352-3927393
Received: September 29, 2013
Revised: November 22, 2013
Accepted: March 7, 2014
Published online: April 7, 2014
Processing time: 186 Days and 15.2 Hours
Abstract

Cirrhosis secondary to hepatitis C virus (HCV) is a very common indication for liver transplant. Unfortunately recurrence of HCV is almost universal in patients who are viremic at the time of transplant. The progression of fibrosis has been shown to be more rapid in the post-transplant patients than in the transplant naïve, hence treatment of recurrent HCV needs to be considered for all patients with documented recurrent HCV. Management of recurrent HCV is a challenging situation both for patients and physicians due to multiple reasons as discussed in this review. The standard HCV treatment with pegylated interferon and Ribavarin can be considered in these patients but it leads to a lower rate of sustained virologic clearance than in the non-transplanted population. Some of the main challenges associated with treating recurrent HCV in post-transplant patients include the presence of cytopenias; need to monitor drug-drug interactions and the increased incidence of renal compromise. In spite of these obstacles all patients with recurrent HCV should be considered for treatment since it is associated with improvement in survival and a delay in fibrosis progression. With the arrival of direct acting antiviral drugs there is renewed hope for better outcomes in the treatment of post-transplant HCV recurrence. This review evaluates current literature on this topic and identifies challenges associated with the management of post-transplant HCV recurrence.

Keywords: Cirrhosis; Hepatitis C; Recurrence; Transplant; Interferon

Core tip: Management of recurrent hepatitis C in post-transplant patient is challenging but can be rewarding as treatment has been shown to improve survival and slow fibrosis progression. This review summarizes major challenges in this population and discusses the natural history of post-transplant Hepatitis C virus (HCV), risk factors for HCV recurrence, management of immunosuppression and current treatment options. The preliminary data on use of newer direct acting antiviral drugs in the post-transplant setting has also been included.