Page 88 - The Flying Publisher Guide to Hepatitis C Treatment

88 | Hepatitis C Treatment

the suspicion of these complications and warrant the
performance of a liver biopsy.

Retransplantation for recurrent HCV cirrhosis

Retransplantation is the only therapeutic option to achieve
long-term survival in patients with decompensated HCV
cirrhosis after LT. Retransplantation for this indication ranges
from 3.6% to 44%. Patient and graft survival rates after
retransplantation are inferior to those after primary LT. HCV-
infected recipients had a significantly lower survival rate
compared to non-HCV-infected patients who underwent
retransplantation at least 90 days after primary LT.
Progression to cirrhosis is faster after retransplantation than
after primary LT, particularly in patients with severe hepatitis C
recurrence (cholestatic hepatitis and graft failure within the first
year) (Carrion 2010). Predictors of poor outcome are: bilirubin
≥10 mg/dL, serum creatinine ≥2 mg/dL, donor age >40, recipient
age >55 and early HCV recurrence (cirrhosis <1 year after LT)
(Wiesner 2003). Thus, the optimal timing to perform elective
retransplantation in HCV patients is a matter of debate.
However, bilirubin and creatinine serum levels are essential for
deciding about retransplantation candidates. Patients with a CTP
score ≥10 or a MELD score >25 have a very high risk of death
after retransplantation.

Outlook

HCV is and will continue to be the most common indication for
LT worldwide and recurrent disease associated with HCV is a
major cause of allograft loss and mortality.
A better understanding of the recipient, donor and viral risk
factors for progressive disease and vigilant post-transplant
monitoring through histologic assessment may guide
management aimed toward reducing the potential for graft
failure as well as helping identify candidates for antiviral
therapy.