For citation purposes: Koppala J, Mukherjee S. Risk factors and management of hepatitis C recurrence after liver transplantation. OA Hepatology 2013 May 01;1(1):3.


Viral Hepatitis

Risk factors and management of hepatitis C recurrence after liver transplantation

J Koppala, S Mukherjee

Authors affiliations

(1) Creighton University Medical Center, Suite 5107, 601 N 30th Street, Omaha NE 68131

(2) Division of Gastroenterology-Hepatology, 983285 Nebraska Medical Center, Omaha NE 68198-3285

*Corresponding author Email:



Liver disease associated with Hepatitis C virus infection is the most common indication for liver transplantation. Patients with detectable hepatitis C virus ribonucleic acid at the time of liver transplantation inevitably experience graft re-infection. This results in 30% of patients to develop cirrhosis in 5 years post liver transplantation, with a rate of decompensation at 1 year of 40%. Achievement of sustained virological response is associated with stabilisation of fibrosis and improvement in graft survival. Standard antiviral therapies using pegylated interferon, ribavirin and retransplantation in decompensated patients were the only options for the treatment.

Direct acting antivirals such as protease inhibitors, polymerase or other non-structural protein inhibitors are new modalities of treatment of Hepatitis C. However, their use in the field of liver transplant is limited due to their safety and tolerance issues. Combination therapy with telaprevir or boceprevir added to pegylated interferon and ribavirin is anticipated to be beneficial but with increased rates of adverse effects and challenges in managing drug–drug interactions between the protease inhibitors and calcineurin inhibitors or sirolimus. The aim of this review was to discuss the risk factors and management of hepatitis C recurrence after liver transplantation.


Hepatitis C virus recurrence is a serious complication in liver transplant patients, where it can cause cirrhosis, graft loss and death in up to 30% of Hepatitis C virus-infected patients. Several strategies to control and minimise the Hepatitis C virus re-infection have been evolving. Direct acting antiviral represents a new era in Hepatitis C virus treatment; however, careful evaluation for drug–drug interactions, tolerance and adverse effects are required.

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