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A Practical Guide to the Management of HCV Infection Following Liver Transplantation

Hepatitis C‐associated liver failure is the most common indication for liver transplantation, with virological recurrence near ubiquitous. Approximately 30% of HCV‐infected recipients will die or lose their allograft or develop cirrhosis secondary to hepatitis C recurrence by the fifth postoperative year, with the proportion increasing with duration of follow‐up. Strategies for minimizing the frequency of severe HCV recurrence include avoidance of older donors, early diagnosis/treatment of CMV and minimization of immunosuppression, particularly T‐cell depleting therapies and pulsed corticosteroid treatment of acute cellular rejection. Patients should be offered treatment with peginterferon and ribavirin before LT if MELD ≤ 17 or as soon as histological evidence of recurrence of HCV is apparent post‐LT. Because of the high frequency of hemotoxicity and renal insufficiency, ribavirin should be dosed according to renal function.