Clinical research on the mechanism of hepatitis C recurrence and its management following liver transplantation for hepatitis C liver cirrhosis

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Virological recurrence after living-donor liver transplantation for Hep C liver cirrhosis is inevitable. Together with the fact that histological recurrence is evident with over 80% cases at 3 years after transplantation, it is obvious that effective treatment and/or effective prophylaxis are necessary.The analysis of recipients with Hep C recurrence (F1 and over) at Kyoto University Hospital revealed risk factors as follows : female recipient, male donor, preoperative interferon therapy, non-small graft. However, even with the recipients without risk factors, the recurrence rate reaches around 80%, therefore, they cannot be classified as group without necessity of treatment.Further investigation at Nagoya University Hospital showed : The extent of post-transplant viral growth is not predictable by the pre-transplant viral load or immediate post-transplant viral load. Viral load (pre-transplant, immediate post-transplant, 1 month after transplant) does not forecast histological recurrence.It is believed that "lower the viral load, greater the effect of anti-virals," however, the usage of interferon immediate after transplantation is fraught with risk of activation of immune system leading to rejection. Our data suggests that some cases encounter histological rejection in the absence of elevated liver function tests, therefore liver biopsy in order to exclude rejection in indispensable when we consider antiviral therapy immediately after transplantation.This research contributes to the management and treatment of Hep C recurrence after liver transplantation. Hereafter, continuing research is necessary regarding steroid-free immunosuppression or virus clearing therapy for viral overshoot after transplantation expecting the mitigation of magnitude of virological recurrence.