A 50-year-old man receives a liver transplant for hepatitis C-related cirrhosis. What is the natural history of this virus post-transplant?
In patients who are HCV RNA-positive at the time of liver transplant, recurrence is universal. In addition, progression to cirrhosis more rapid in transplanted than native livers; 10-30% of patients will develop cirrhosis within 5 years post-liver transplant for hepatitis C, and long-term survival of HCV-positive liver recipients is decreased compared to patients who receive liver transplants for other indications. Factors associated with accelerated progression of recurrent HCV post-liver transplant include older donor age and use of high-dose steroid boluses for treating acute cellular rejection.
Hepatitis C may also progress more rapidly post-transplant in recipients of non-liver transplants as well. Careful assessment of patients with HCV pre-transplant should include an assessment of viral load, liver synthetic function, portal pressures and histologic changes. Treatment of HCV post-transplant is currently limited, as interferon, which is the cornerstone of therapy, may precipitate episodes of rejection.