Natural History of Recurrent Hepatitis C: Impact of Immunosuppression

摘要: Chronic infection with the hepatitis C virus is at epidemic proportions and currently leading indication for liver transplantation. Despite advances in antiviral therapies, many patients remain infected time of transplant. In this circumstance, allograft universally becomes infected. The recurrent viral can follow a more aggressive accelerated course posttransplant setting an early, rapid increase graft fibrosis followed by linear after 3 years. Multiple factors are known to affect rate progression chronic C, including genetic, operative, donor, recipient factors. Immunosuppression appears also play profound role disease, but understudied not well understood. Bolus corticosteroids associated increased fibrosis, loss worse overall survival, thus their use needs be balanced based on competing goals virologic control prevention or treatment cellular rejection. Induction steroids, other hand, do appear detrimental if tapered slowly prevent damage from immune reconstitution. There no significant difference choice calcineurin inhibitor used maintenance therapy. antimetabolites such as mycophenolate mofetil neutral beneficial while certain T-cell depletion therapies severe recurrence disease recommended. effect mTOR inhibitors controversial unclear, therefore these agents should caution until further studies available.