Liver transplantation in the setting of chronic HCV.

摘要: Recurrent HCV disease is the most common cause of graft loss and patient mortality in HCV-infected liver transplant (LT) recipients. Risk factors for more severe recurrence that are potentially modifiable older donor age, prolonged cold ischaemia time, prior treated acute rejection, CMV hepatitis, IL28B genotype, post-LT insulin resistance. The effective means preventing eradicating to LT. Select wait-list candidates with compensated or mildly decompensated can be considered antiviral treatment peginterferon, ribavirin (and protease inhibitor if genotype 1). For majority LT patients, must delayed until post-transplant. Treatment generally undertaken histologic severity reaches grade 3 4 necroinflammation stage ≥2 fibrosis, cholestatic hepatitis. Achievement sustained viral response (SVR) associated stabilization fibrosis improved survival. SVR attained ~30% patients peginterferon ribavirin. Poor tolerability therapy a limitation. Combination telaprevir boceprevir added anticipated increase efficacy but higher rates adverse effects challenges managing drug-drug interactions between inhibitors calcineurin inhibitors/sirolimus.