Chronic Viral Hepatitis and Liver Transplantation

Abstract

End-stage liver disease, secondary to chronic hepatitis C virus (HCV) infection, is the most common indication for liver transplantation worldwide. Historically, the first liver transplantations, for decompensated cirrhosis caused by chronic viral hepatitis, were performed in the 1970s, in patients with chronic hepatitis B virus (HBV) infection. According to data from the United Network of Organ Sharing (UNOS), of the more than 4000 liver transplantations performed annually in the United States from 1994 to 1998, 23% were for chronic hepatitis C (CHC), 16% for alcoholic cirrhosis, 7% for both alcoholic cirrhosis and hepatitis C, 4% for chronic hepatitis B, and 4% for acute liver failure, including hepatitis A or hepatitis B(1). Liver transplantation for chronic viral hepatitis has evolved rapidly over the past two decades, with reduced re-infection rates and improved outcomes for patients with end-stage chronic hepatitis B,and the rise of CHC as the most common indication for liver transplantation. The optimal management of the patient with moderate or severe recurrent hepatitis C after liver transplantation is the focus of intense study, but continues to remain uncertain.