Natural history, risk factors and management of hepatitis C after liver transplantation.

Recurrent HCV is universal after liver transplantation in patients viremic at the time of transplantation and leads to cirrhosis in up to 30% of patients by five years. This has led to recurrent HCV emerging as an important yet controversial indication for liver retransplantation. Despite encouraging results with pegylated interferon and ribavirin therapy in the non-transplant HCV population, these findings have not translated to transplant recipients where viral eradication is frequently unsuccessful largely due to drug intolerance. The lack of effective therapies, severe side effects and reports of hepatic decompensation despite HCV eradication raises the question of whether recurrent HCV genotype 1 should be treated with interferon-based therapies. Although protease inhibitors were recently approved for the treatment of genotype 1 HCV patients in combination with pegylated interferon and ribavirin, these new agents are contraindicated in liver transplant patients due to severe drug toxicity.