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| 1 | Challenges of recurrent hepatitis C in the liver transplant patient显示文摘Cirrhosis secondary to hepatitis C virus(HCV)is a very common indication for liver transplant.Unfortunately recurrence of HCV is almost universal in patients who are viremic at the time of transplant.The progression of fibrosis has been shown to be more rapid in the post-transplant patients than in the transplant na?ve,hence treatment of recurrent HCV needs to be considered for all patients with documented recurrent HCV.Management of recurrent HCV is a challenging situation both for patients and physicians due to multiple reasons as discussed in this review.The standard HCV treatment with pegylated interferon and Ribavarin can be considered in these patients but it leads to a lower rate of sustained virologic clearance than in the nontransplanted population.Some of the main challenges associated with treating recurrent HCV in post-transplant patients include the presence of cytopenias;need to monitor drug-drug interactions and the increased incidence of renal compromise.In spite of these obstacles all patients with recurrent HCV should be considered for treatment since it is associated with improve-ment in survival and a delay in fibrosis progression.With the arrival of direct acting antiviral drugs there is renewed hope for better outcomes in the treatment of post-transplant HCV recurrence.This review evaluates current literature on this topic and identifies challenges associated with the management of post-transplant HCV recurrence. | Renumathy Dhanasekaran Roberto J Firpi | 2014 | World Journal of Gastroenterology2014，20，13： | 1 |
| 2 | Post-liver transplant hepatitis C virus recurrence: An unresolved thorny problem显示文摘Hepatitis C virus(HCV)-related cirrhosis represents the leading cause of liver transplantation in developed, Western and Eastern countries. Unfortunately, liver transplantation does not cure recipient HCV infection: reinfection universally occurs and disease progression is faster after liver transplant. In this review we focus on what happens throughout the peri-transplant phase and in the first 6-12 mo after transplantation: during this crucial period a completely new balance between HCV, liver graft, the recipient's immune response and anti-rejection therapy is achieved that will deeply affect subsequent outcomes. Nearly all patients show an early graft reinfection, with HCV viremia reaching and exceeding pre-transplant levels; in this setting, histological assessment is essential to differentiate recurrent hepatitis C from acute or chronic rejection; however, differentiating the two patterns remains difficult. The host immune response(mainly cellular mediated) appears to be crucial both in the control of HCV infection and in the genesis of rejection, and it is also strongly influenced by immunosuppressive treatment. At pres-ent no clear immunosuppressive strategy could be strongly recommended in HCV-positive recipients to prevent HCV recurrence, even immunotherapy appears to be ineffective. Nonetheless it seems reasonable that episodes of rejection and over-immunosuppression are more likely to enhance the risk of HCV recurrence through immunological mechanisms. Both complete prevention of rejection and optimization of immunosuppression should represent the main goals towards reducing the rate of graft HCV reinfection. In conclusion, post-transplant HCV recurrence remains an unresolved, thorny problem because many factors remain obscure and need to be better determined. | Alberto Grassi Giorgio Ballardini | 2014 | World Journal of Gastroenterology2014，20，32： | 0 |
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