Recurrent allograft disease: viral hepatitis.

Viral hepatitis is the leading indication for liver transplantation (LT) in the majority of transplant centers. Post-transplantation outcome in these patients largely depends on the prevention of allograft reinfection. In contrast to hepatitis B where excellent results have been achieved following the implementation of effective measures to prevent HBV, recurrent hepatitis C is an increasing problem facing liver transplant hepatologists and surgeons. HBV recurrence is effectively contained by the use of hepatitis B inmunoglobulins with antivirals. Unfortunately, no effective prophylactic therapy is available for hepatitis C so that recurrent hepatitis C occurs almost invariably. Progression to severe allograft fibrosis is often rapid. Current antivirals, including peg-interferons, are limited by substantial toxicities that compromise their efficacy. Hence, it is not surprising that although some improvements have been made in the treatment of recurrent hepatitis C, a substantial proportion of HCV-infected patients develop recurrent allograft end-stage liver disease leading to a decrease in graft survival, an increase in the need for re-transplantation, and ultimately, a decrease in patient survival.