Immunopathogenesis and outcomes of recurrent hepatitis C

Abstract

In the Western world, hepatitis C virus (HCV)-related end-stage liver disease is the leading indication for liver transplantation (LT). Based on the presence of HCV RNA in the serum, recurrence is immediate and universal, with nearly all patients developing some evidence of histological recurrence. (Acute hepatitis occurs in 60-80% at a median of 4-6 mo post transplantation and chronic hepatitis in 80-100% by 1-4 yr [1-3]. Reports indicate that 20 to 40% of recipients with recurrent HCV disease progress to allograft cirrhosis within 5 yr compared with less than 5% of nontransplant chronic HCV patients; thus, the natural history of recurrent HCV is accelerated compared with the nontransplant setting (4-5). Once cirrhosis develops in the transplant setting, two-thirds will develop decompensation (ascites, variceal hemorrhage, encephalopathy) within 3 yr (15-6). The development of decompensation is associated with a very poor outcome, with only about 10% surviving for 3 yr. Despite this accelerated course, approximately a third of patients demonstrate only minimal fibrosis after 5 yr of follow-up (7). The use of protocol liver biopsies is justified in patients transplanted for HCV based on the increasing probability of severe histological findings (stage 3 or 4) (8-9). © 2007 Humana Press Inc.