Scott W Biggins MD Norah A Terrault MD MPH

Division of Gastroenterology, Department of Medicine, University of California, San Francisco, 513 Parnassus Ave, S357, Box 0538 San Francisco, CA 94143, USA

Chronic hepatitis C virus (HCV) infection is the most common indication for liver transplantation in the United States and Europe, and more than 20,000 patients worldwide have undergone transplantation for complications of chronic hepatitis C. In North America, HCV accounts for 15% to 50% of all liver transplants performed [1]. Available prevalence data predict that this proportion will likely increase as the number of persons with chronic hepatitis C developing cirrhosis and hepatocellular carcinoma in North America rises over the next 1 to 2 decades [2,3].

Recurrent HCV infection is universal in those with viremia before transplantation, and the rate of histologic disease progression after transplantation is more rapid. The risk of death and allograft failure is increased in HCV-positive transplant recipients (hazard ratio [HR] 1.23 and 1.30) compared with HCV-negative recipients [4]. The risk of cirrhosis is as high as 30% within 5 to 10 years after transplantation [5-7]. Retransplantation for recurrent hepatitis C is an option for only a limited number of patients, and with a 5-year survival rate of % 50%, it is likely to remain a controversial indication for retransplantation [8].

To maximize the long-term survival of liver transplant recipients who have HCV infection, eradication of infection is the ultimate goal. Pretrans-plant antiviral therapy with the goal of achieving viral eradication before transplantation is a consideration in some patients, especially those who have mildly decompensated liver disease [9]. This article focuses on the management of liver transplant recipients who have HCV infection at the time of transplantation. This group of patients is at risk for recurrent and progressive disease after transplantation. There are several different time points for

A version of this article originally appeared in the 9:3 issue of Clinics in Liver Disease.

* Corresponding author.

E-mail address: [email protected] (N.A. Terrault).

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