Liver Transplantation for Hepatitis B and C
Liver transplantation (LTx) is considered effective therapy for patients with end-stage liver disease. Unfortunately, the results of TLx for patients with chronic viral hepatitis has not been as promising as for other liver disorders. A high rate of hepatitis recurrence in the allograft leading to a high incidence of graft and patient loss have led many transplant centers to reassess the use of LTx in these groups. Current strategies to prevent hepatitis B and C viral (HBV, HBC) reinfection focus on identifying patients with a low risk of reinfection, specifically those with markers for a low level of or no viremia. Trials to convert “high risk” hepatitis patients to “low risk” status have been initiated with the aim to reduce the viral burden at the time of LTx. Antiviral agents or immunostimulatory therapy before or after LTx (or at both times) have been proposed as a means to minimize recurrence of hepatitis in the liver allograft. Although this approach has been effective for HBV infection (i.e., with the use of hepatitis B immune globulin and nucleoside analogs, specifically lamivudine), this approach has not been as effective for the prevention or treatment of HCV infection. Ongoing trials are assessing the use of antibodies to HCV during the early posttransplant period as well as the use of α-interferon and ribaviron. Despite the lack of overwhelming efficacy of these approaches for HCV, the impact of recurrent HCV following LTx is less significant, at least during the early posttransplant period.