Hepatitis B and C in the Liver Transplant Recipient
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.
Liver disease related to chronic viral hepatitis, such as hepatitis B and C, is the leading indication for ortho-topic liver transplantation (OLT) worldwide. In addition, viral reinfection of the liver allograft may lead to graft failure, death, or the need for retransplantation. Although additional viruses that may infect the liver (e.g., hepatitis G and TT-V) have been identified, their significance as major causes of liver disease remains unclear. Therefore, the focus of this review will be the hepatitis B and hepatitis C viruses, including their natural history following liver transplantation, mechanisms of recur-rence, pathogenesis, and treatment.
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.
Liver disease related to chronic viral hepatitis, such as hepatitis B and C, is the leading indication for ortho-topic liver transplantation (OLT) worldwide. In addition, viral reinfection of the liver allograft may lead to graft failure, death, or the need for retransplantation. Although additional viruses that may infect the liver (e.g., hepatitis G and TT-V) have been identified, their significance as major causes of liver disease remains unclear. Therefore, the focus of this review will be the hepatitis B and hepatitis C viruses, including their natural history following liver transplantation, mechanisms of recur-rence, pathogenesis, and treatment.
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