Recurrent allograft disease : viral hepatitis

Viral hepatitis is the leading indication for liver transplantation (LT) in the majority of transplant centers. Post-transplantation outcome in these patients largely depends on the prevention of allograft reinfection. In contrast to hepatitis B where excellent results have been achieved following the implementation of effec- tive measures to prevent HBV (1,2), recurrent hepatitis C is an increasing problem facing liver transplant hepatologists and sur- geons (3-5). HBV recurrence is effectively contained by the use of hepatitis B inmunoglobulins with antivirals (6,7). Unfortunately, no effective prophylactic therapy is available for hepatitis C so that recurrent hepatitis C occurs almost invariably. Progression to severe allograft fibrosis is often rapid. Current antivirals, includ- ing peg-interferons, are limited by substantial toxicities that com- promise their efficacy (3,8). Hence, it is not surprising that although some improvements have been made in the treatment of recurrent hepatitis C, a substantial proportion of HCV-infected patients develop recurrent allograft end-stage liver disease leading to a decrease in graft survival, an increase in the need for re-trans- plantation, and ultimately, a decrease in patient survival (4,5). (Acta gastroenterol. belg., 2005, 68, 337-346).