Purpose of review: A clear understanding of the natural history of recurrent hepatitis C virus (HCV) infection and optimal management are essential given the universal allograft reinfection and the steady increase in the prevalence of patients in need of liver transplantation due to advanced HCV-related liver disease.
Recent findings: Natural history studies have demonstrated that recurrent diseases progresses more rapidly in the transplant setting than in the immune-competent host, leading to allograft cirrhosis in a substantial proportion of patients only 5-10 years after transplantation and to subsequent impairment in graft and patient survival. The quality of the donor and the management of immunosuppression play major roles in disease progression. Although hampered by low tolerability and efficacy, antiviral therapy, particularly with pegylated interferon plus ribavirin, is the best strategy to treat recurrent hepatitis.
Summary: A better understanding of the association between immunosuppression and HCV-related fibrosis progression is imperative to improve the outcome. Organ allocation may need to be revisited in the face of the strong association between old donor age and aggressive disease. Optimising antiviral therapy with better definitions of doses, durations, time for initiation, and role of growth factors is a great challenge for future studies.