Natural history of hepatitis C following liver transplantation

[Guest guest]

CURRENT OPINION IN INFECTIOUS DISEASES

August 2004, 17:4

Natural history of hepatitis C following liver transplantation.

Current Opinion in Infectious Diseases. 17(4):363-371, August 2004.

-Luna, ; , D

Abstract:

Purpose of review: Currently, chronic hepatitis C virus-infection-related

cirrhosis is the most common indication for liver transplantation in the USA

and most parts of the world. While the incidence of new hepatitis C virus

cases has decreased, the prevalence of infection will not peak until the

year 2040. In addition, as the duration of infection increases, the

proportion of new patients with cirrhosis will double by 2020 in an

untreated patient population. If this model is correct, the projected

increase in the need for liver transplantation secondary to chronic

hepatitis C virus infection will place an impossible burden on an already

limited supply of organs. In this article we present a comprehensive review

of post-transplant hepatitis C virus infection and address the major

challenges that face the transplant community.

Recent findings: Hepatitis C virus infection recurs virtually in every

post-transplant patient. Typically, serum levels of hepatitis C virus RNA

increase rapidly from week 2 post-liver transplant, achieving 1-year

post-liver transplant levels that are 10-20-fold greater than the mean

pre-liver transplant levels. Progression of chronic hepatitis C virus is

more aggressive after liver transplantation with a cumulative probability of

developing graft cirrhosis estimated to reach 30% at 5 years. Approximately

10% of the patients with recurrent disease will die or require

re-transplantation within 5 years post-transplantation. Interventions to

prevent, improve, or halt the recurrence of hepatitis C virus infection have

been evaluated by multiple small studies worldwide with similar overall

rates of virological clearance of approximately 9-30%. Current consensus

recommends combination therapy with pegylated interferon and ribavirin for

those patients with histological recurrence of hepatitis C virus infection

and fibrosis of >=2/4. Therapy is adjusted to tolerance and rescued with

granulocyte colony-stimulating factor and erythropoietin for bone marrow

suppression.

Summary: The major challenges that face the transplant community in the

coming years include new strategies to meet the growing demand for limited

organ donor supplies and improvement of treatment for those patients in whom

recurrence of viral disease has occurred. Only with improved antiviral

treatments and strategies will we make a significant impact on this problem.

© 2004 Lippincott & Wilkins, Inc.

[Guest guest]

CURRENT OPINION IN INFECTIOUS DISEASES

August 2004, 17:4

Natural history of hepatitis C following liver transplantation.

Current Opinion in Infectious Diseases. 17(4):363-371, August 2004.

-Luna, ; , D

Abstract:

Purpose of review: Currently, chronic hepatitis C virus-infection-related

cirrhosis is the most common indication for liver transplantation in the USA

and most parts of the world. While the incidence of new hepatitis C virus

cases has decreased, the prevalence of infection will not peak until the

year 2040. In addition, as the duration of infection increases, the

proportion of new patients with cirrhosis will double by 2020 in an

untreated patient population. If this model is correct, the projected

increase in the need for liver transplantation secondary to chronic

hepatitis C virus infection will place an impossible burden on an already

limited supply of organs. In this article we present a comprehensive review

of post-transplant hepatitis C virus infection and address the major

challenges that face the transplant community.

Recent findings: Hepatitis C virus infection recurs virtually in every

post-transplant patient. Typically, serum levels of hepatitis C virus RNA

increase rapidly from week 2 post-liver transplant, achieving 1-year

post-liver transplant levels that are 10-20-fold greater than the mean

pre-liver transplant levels. Progression of chronic hepatitis C virus is

more aggressive after liver transplantation with a cumulative probability of

developing graft cirrhosis estimated to reach 30% at 5 years. Approximately

10% of the patients with recurrent disease will die or require

re-transplantation within 5 years post-transplantation. Interventions to

prevent, improve, or halt the recurrence of hepatitis C virus infection have

been evaluated by multiple small studies worldwide with similar overall

rates of virological clearance of approximately 9-30%. Current consensus

recommends combination therapy with pegylated interferon and ribavirin for

those patients with histological recurrence of hepatitis C virus infection

and fibrosis of >=2/4. Therapy is adjusted to tolerance and rescued with

granulocyte colony-stimulating factor and erythropoietin for bone marrow

suppression.

Summary: The major challenges that face the transplant community in the

coming years include new strategies to meet the growing demand for limited

organ donor supplies and improvement of treatment for those patients in whom

recurrence of viral disease has occurred. Only with improved antiviral

treatments and strategies will we make a significant impact on this problem.

© 2004 Lippincott & Wilkins, Inc.

[Guest guest]

CURRENT OPINION IN INFECTIOUS DISEASES

August 2004, 17:4

Natural history of hepatitis C following liver transplantation.

Current Opinion in Infectious Diseases. 17(4):363-371, August 2004.

-Luna, ; , D

Abstract:

Purpose of review: Currently, chronic hepatitis C virus-infection-related

cirrhosis is the most common indication for liver transplantation in the USA

and most parts of the world. While the incidence of new hepatitis C virus

cases has decreased, the prevalence of infection will not peak until the

year 2040. In addition, as the duration of infection increases, the

proportion of new patients with cirrhosis will double by 2020 in an

untreated patient population. If this model is correct, the projected

increase in the need for liver transplantation secondary to chronic

hepatitis C virus infection will place an impossible burden on an already

limited supply of organs. In this article we present a comprehensive review

of post-transplant hepatitis C virus infection and address the major

challenges that face the transplant community.

Recent findings: Hepatitis C virus infection recurs virtually in every

post-transplant patient. Typically, serum levels of hepatitis C virus RNA

increase rapidly from week 2 post-liver transplant, achieving 1-year

post-liver transplant levels that are 10-20-fold greater than the mean

pre-liver transplant levels. Progression of chronic hepatitis C virus is

more aggressive after liver transplantation with a cumulative probability of

developing graft cirrhosis estimated to reach 30% at 5 years. Approximately

10% of the patients with recurrent disease will die or require

re-transplantation within 5 years post-transplantation. Interventions to

prevent, improve, or halt the recurrence of hepatitis C virus infection have

been evaluated by multiple small studies worldwide with similar overall

rates of virological clearance of approximately 9-30%. Current consensus

recommends combination therapy with pegylated interferon and ribavirin for

those patients with histological recurrence of hepatitis C virus infection

and fibrosis of >=2/4. Therapy is adjusted to tolerance and rescued with

granulocyte colony-stimulating factor and erythropoietin for bone marrow

suppression.

Summary: The major challenges that face the transplant community in the

coming years include new strategies to meet the growing demand for limited

organ donor supplies and improvement of treatment for those patients in whom

recurrence of viral disease has occurred. Only with improved antiviral

treatments and strategies will we make a significant impact on this problem.

© 2004 Lippincott & Wilkins, Inc.

[Guest guest]

CURRENT OPINION IN INFECTIOUS DISEASES

August 2004, 17:4

Natural history of hepatitis C following liver transplantation.

Current Opinion in Infectious Diseases. 17(4):363-371, August 2004.

-Luna, ; , D

Abstract:

Purpose of review: Currently, chronic hepatitis C virus-infection-related

cirrhosis is the most common indication for liver transplantation in the USA

and most parts of the world. While the incidence of new hepatitis C virus

cases has decreased, the prevalence of infection will not peak until the

year 2040. In addition, as the duration of infection increases, the

proportion of new patients with cirrhosis will double by 2020 in an

untreated patient population. If this model is correct, the projected

increase in the need for liver transplantation secondary to chronic

hepatitis C virus infection will place an impossible burden on an already

limited supply of organs. In this article we present a comprehensive review

of post-transplant hepatitis C virus infection and address the major

challenges that face the transplant community.

Recent findings: Hepatitis C virus infection recurs virtually in every

post-transplant patient. Typically, serum levels of hepatitis C virus RNA

increase rapidly from week 2 post-liver transplant, achieving 1-year

post-liver transplant levels that are 10-20-fold greater than the mean

pre-liver transplant levels. Progression of chronic hepatitis C virus is

more aggressive after liver transplantation with a cumulative probability of

developing graft cirrhosis estimated to reach 30% at 5 years. Approximately

10% of the patients with recurrent disease will die or require

re-transplantation within 5 years post-transplantation. Interventions to

prevent, improve, or halt the recurrence of hepatitis C virus infection have

been evaluated by multiple small studies worldwide with similar overall

rates of virological clearance of approximately 9-30%. Current consensus

recommends combination therapy with pegylated interferon and ribavirin for

those patients with histological recurrence of hepatitis C virus infection

and fibrosis of >=2/4. Therapy is adjusted to tolerance and rescued with

granulocyte colony-stimulating factor and erythropoietin for bone marrow

suppression.

Summary: The major challenges that face the transplant community in the

coming years include new strategies to meet the growing demand for limited

organ donor supplies and improvement of treatment for those patients in whom

recurrence of viral disease has occurred. Only with improved antiviral

treatments and strategies will we make a significant impact on this problem.

© 2004 Lippincott & Wilkins, Inc.