Hepatitis C virus (HCV) infection causes about 40 percent of all chronic liver disease in the United States and HCV-associated cirrhosis is the most common indication for orthotopic liver transplantation (OLT) among adults [1,2]. HCV infection remains a problem after transplantation and recurrent hepatic infection is the leading cause of graft failure.
The major issues related to HCV following liver transplantation will be reviewed here. Similar problems arise in patients with HCV who undergo other forms of organ transplantation. (See "Hepatitis C virus infection and renal transplantation".)
The natural history and treatment of HCV, as well as the selection of patients for liver transplantation is discussed elsewhere. (See "Clinical manifestations and natural history of chronic hepatitis C virus infection" and "Overview of the management of chronic hepatitis C virus infection" and "Treatment regimens for chronic hepatitis C virus genotype 1" and "Treatment regimens for chronic hepatitis C virus genotypes 2, 3, and 4" and "Patient selection for liver transplantation".)
Recurrence of HCV following orthotopic liver transplantation (OLT) occurs in over 95 percent of patients [3,4]. Nucleotide sequence studies of HCV demonstrate that the disease following OLT results from the same viral strain present before OLT. Virologic reinfection at the time of transplantation is not surprising, since almost all patients are viremic at this time . Reinfection occurs during reperfusion of the allograft in the operating room, and viral titers reach pretransplant levels within 72 hours . Furthermore, peripheral monocytes may also harbor virus and act as a source for reinfection of the donor liver . De novo infection in previously HCV-negative patients can result from transfusion of blood products during OLT but has become rare since 1992 due to blood product screening.
Variables that influence the progression of recurrent HCV following orthotopic liver transplantation (OLT) are incompletely understood, but donor characteristics (donor type, age), viral characteristics (genotype, viral load), the inflammatory grade of the explanted liver, and the patient's immune status and immunosuppressive regimen may be important [7-20].