Management of recurrent hepatitis C following liver transplantation.

Hepatitis C virus (HCV) is the most common indication for liver transplantation in the United States, and recurrent disease associated with HCV is a major cause of allograft loss and mortality. Up to 30% of transplant recipients with HCV will develop progressive fibrosis and cirrhosis within 5 years of transplantation. Several recipient, donor, and viral factors have been identified as risk factors for disease progression. Likewise, immunosuppression with pulse corticosteroids or T-cell-depleting therapies such as muromonab-CD3 have been linked to HCV-associated allograft failure. Antiviral therapy with peginterferon alfa and ribavirin should be considered in select transplant recipients with recurrent HCV infection, as achievement of sustained virologic response is associated with increased allograft and patient survival; however, efficacy may be limited by poor tolerability, requirement for dose reductions, and treatment discontinuation. The use of emerging therapies such as direct-acting antiviral agents and steroid-sparing immunosuppression may play a major role in further advances associated with post-transplant management of recurrent HCV infection.