Mechanisms of HCV reinfection and allograft damage after liver transplantation

Hepatitis C: a challenge to hepatologists and to the liver transplantation team

“…Studies have suggested intra-operative re-infection of the liver graft at time of reperfusion 24 . There is a high probability that the source is the blood itself 25 . The viral load can return to the pre transplant values within 4 days after transplantation and may be influenced by the intraoperative or peroperative use of corticosteroids.…”

“…Acute hepatitis occurs between 2-5 months post transplant and it is characterized by acute lobular hepatitis. A higher viral load and cellular immune response and a higher rate of cell proliferation and apoptosis are observed compared to chronic hepatitis 25 .…”

Antiviral treatment of recurrent hepatitis C after liver transplantation

“…FCH usually occurs during the first posttransplantation year, represents 10% of the cases of posttransplantation hepatitis, and is characterized by the association of jaundice and liver failure. 7 FCH appears to arise from the inability of the immune system of the recipient to clear HCV from the liver, leading to a very high HCV load in the graft associated with a stable HCV quasispecies. 8 It has therefore been suggested that in this particular context, HCV becomes cytopathic.…”

“…8 It has therefore been suggested that in this particular context, HCV becomes cytopathic. 7 Otherwise, the course is more classical, but much more rapid than in immunocompetent patients. Acute hepatitis occurs between 1 and 4 months posttransplantation followed by a chronic course.…”

“…Recently, it has also been suggested that the rapid withdrawal of steroids 16 could be responsible for an immune rebound, deleterious for the graft. 7 The respective role of anti-IL2 receptors, tacrolimus, cyclosporine and mycophenolate mofetil is still debated; however, rejection episodes and treatment of rejection were associated with rapid progression of fibrosis. 17 Thus, it appears important to offer antiviral therapy to liver transplant recipients at the risk of severe recurrence of chronic hepatitis C. Treatment can be done before liver transplantation in selected patients with Child A or B cirrhosis.…”