Controversies in liver transplantation for hepatitis C.

[mikesimon]

Controversies in liver transplantation for hepatitis C.
Mukherjee S, Sorrell MF.

Section of Gastroenterology and Hepatology, Nebraska Medical Center, Omaha, Nebraska 68198-3285, USA. ***@****

Hepatitis C is one of the most common indications for liver transplantation in the United States, accounting for approximately 40%-45% of all liver transplants. Unfortunately, recurrent disease is universal in patients who are viremic before transplantation. This can lead to cirrhosis in at least 25% of patients 5 years after liver transplantation, and recurrent hepatitis C is now emerging as an important but occasionally contentious indication for retransplantation. Several attempts have been undertaken to identify patients at high risk for severe recurrent disease who may benefit from treatment, but unfortunately antiviral therapy frequently is ineffective and often is associated with numerous side effects. Although we have made significant strides in understanding the natural history of this disease in nontransplant patients, this does not hold true for the transplant population in which several uncertainties covering virtually the entire spectrum of liver transplantation persist. Despite these concerns, on a more practical level, it is usually only in the postoperative setting that clinicians truly can assess the impact of their interventions on the natural history of recurrent hepatitis C, for example, by adjusting immunosuppression or prescribing antiviral therapy. Preoperative and perioperative (including donor) factors often are outside the control of hepatologists and transplant surgeons. This review is not an inclusive review of the literature but summarizes what we believe are the more controversial topics of this disease.

PMID: 18471554 [PubMed - in process

Mike

[child24angel]

Thanks again Mike

Hoping some of the newer drugs will help those
who are post transplant and have to rid the virus again.
Maybe there will be less need for retransplant in the future

Hugs
Elaine.

[IAmTheWalrus]

That is one of the main benefits of a transplant in a HEP C patient; time to treat. With a new liver, the patient has the time and option of treating with SOC or, often, enough time to wait for newer drugs. I am going the SOC route rather than waiting and risking damage to my new liver (unfortunately my reinfection progressed rather rapidly). If SOC doesn't work, I'lll be in line for a trial, if it becomes available.

Brent

[child24angel]

I understand your reinfection was rapid.
I'm glad you started tx and will be SVR Brent !
You are doing great !!
Hugs
Elaine