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14 Hepatitis C and liver transplantation

DOI: 10.1016/s1874-5326(00)80018-6
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Publisher Summary This chapter discusses the implication of liver transplantation for hepatitis C. The hepatitis C virus (HCV) disease is a common indication for liver transplantation, accounting for 25–50% of all indications in most transplant centers. Whether progression is enhanced by definable factors is not yet fully established, but HCV RNA levels pretransplantation and/or early following transplantation, as well as potent immunosuppression, appear to influence the posttransplantation course. Strategies to prevent or reduce the effect of HCV infection after liver transplantation are therefore desirable. Our ability to intervene in this disease is, however, limited. The main obstacles are the difficulty in predicting the outcome for the individual patient and the lack of effective therapy. In contrast to hepatitis B, where hepatitis B immune globulin has had a positive effect, therapeutic strategies aimed at preventing the recurrence of HCV have had limited efficacy. Both interferon and ribavirin, when given as single agents, rarely result in sustained viral clearance. However, administration of both drugs given in combination either to prevent disease or to treat recurrence when it occurs appears more promising. The inability of currently available antiviral therapy to eliminate HCV in the liver transplant setting suggests that indefinite treatment designed to suppress the effects of the virus may be necessary.

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