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World J Hepatol. May 27, 2013; 5(5): 237-250
Published online May 27, 2013. doi: 10.4254/wjh.v5.i5.237
Strategies to reduce hepatitis C virus recurrence after liver transplantation
Ruben Ciria, María Pleguezuelo, Shirin Elizabeth Khorsandi, Diego Davila, Abid Suddle, Hector Vilca-Melendez, Sebastian Rufian, Manuel de la Mata, Javier Briceño, Pedro López Cillero, Nigel Heaton
Ruben Ciria, Shirin Elizabeth Khorsandi, Diego Davila, Abid Suddle, Hector Vilca-Melendez, Nigel Heaton, Institute of Liver Studies, King’s College Hospital, London SE5 9RS, United Kingdom
María Pleguezuelo, Manuel de la Mata, Unit of Hepatology and Liver Transplantation, University Hospital Reina Sofía, s/n 1400 Córdoba, Spain
Sebastian Rufian, Javier Briceño, Pedro López Cillero, Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, s/n 1400 Córdoba, Spain
Author contributions: All the authors significantly contributed to conception and design, drafting the article and revising it critically and gave final approval of the version to be published.
Supported by The contribution of Ruben Ciria has been possible thanks to the support of a scholarship from the Sociedad Española de Trasplante Hepático (SETH-2009)
Correspondence to: Ruben Ciria, MD, PhD, Institute of Liver Studies, King’s College Hospital, Cheyne Wing, 3rd floor, Denmark Hill, London SE5 9RS, United Kingdom.
Telephone: +44-957-010439 Fax: +44-957-010949
Received: August 19, 2012
Revised: November 16, 2012
Accepted: December 1, 2012
Published online: May 27, 2013

Hepatitis C virus (HCV) is a major health problem that leads to chronic hepatitis, cirrhosis and hepatocellular carcinoma, being the most frequent indication for liver transplantation in several countries. Unfortunately, HCV re-infects the liver graft almost invariably following reperfusion, with an accelerated history of recurrence, leading to 10%-30% of patients progressing to cirrhosis within 5 years of transplantation. In this sense, some groups have even advocated for not re-transplanting this patients, as lower patient and graft outcomes have been reported. However, the management of HCV recurrence is being optimized and several strategies to reduce post-transplant recurrence could improve outcomes, decrease the rate of re-transplantation and optimize the use of available grafts. Three moments may be the focus of potential actions in order to decrease the impact of viral recurrence: the pre-transplant moment, the transplant environment and the post-transplant management. In the pre-transplant setting, it is not well established if reducing the pre transplant viral load affects the risk for HCV progression after transplant. Obviously, antiviral treatment can render the patient HCV RNA negative post transplant but the long-term benefit has not yet been fully established to justify the cost and clinical risk. In the transplant moment, factors as donor age, cold ischemia time, graft steatosis and ischemia/reperfusion injury may lead to a higher and more aggressive viral recurrence. After the transplant, discussion about immunosuppression and the moment to start the treatment (prophylactic, pre-emptive or once-confirmed) together with new antiviral drugs are of interest. This review aims to help clinicians have a global overview of post-transplant HCV recurrence and strategies to reduce its impact on our patients.

Keywords: Hepatitis C virus, Recurrence, Liver, Transplantation, Outcomes