Viral hepatitis in the liver transplant recipient

Liver disease related to chronic viral hepatitis is the leading indicator for orthotopic liver transplantation (OLT). Understanding of hepatitis B and C infections in the OLT recipient has increased, but further study is required. The risk of spontaneous viral recurrence after transplantation has decreased dramatically with the use of hepatitis B immunoglobulin (HBIG) and lamivudine in hepatitis B-infected recipients. As defined by histologic injury, hepatitis C virus (HCV) recurrence is almost universal. Although outcomes for the first decade after OLT do not appear to be limited by hepatitis C viral infection for most patients, individual patients do suffer severe graft injury and even loss caused by recurrent HCV. With longer follow-up, the prevalence of HCV-related graft failure is likely to increase. In addition, the effect on recurrence of different immunosuppressive protocols requires further study. Thus, although hepatitis B recurrence has been effectively contained, the more intractable problem of managing recurrent HCV as yet has no obvious solutions. Optimal antiviral strategies for hepatitis C following OLT have yet to be identified.