M. Bahra, P. Neuhaus, U. P. Neumann

Abstract

Hepatitis C associated liver cirrhosis has become one of the major indications for orthotopic liver transplantation. In nearly 100 % of all cases reinfection occurs in the transplanted liver. In contrast to hepatitis B, there is still no adequate prophylaxis to avoid reinfection. In this condition, severity of reinfection hepatitis is aggravating with time and 30% of patients will develop severe reinfection hepatitis leading to large fibrosis or liver cirrhosis. Observations suggesting reduction of patient and graft survival have not been confirmed by studies. In the meantime several factors, e. g. virus genotype, donor age, frequency and therapy of acute rejection episodes, have been identified, which showed positive correlation to severity of reinfection hepatitis. Influence of immunosuppressive therapy is still being discussed. As could be demonstrated, type and characteristics of immunosuppression play an important role in the development of severe fibrosis. Fibrogenesis in reinfection hepatitis has to be considered as a multifactorial process, optimal immunosuppression being only one of several factors. New immunosuppressive regimen and antiviral therapy strategies using pegylated interferon in combination with ribavirin have been established now and are subjected to further evaluation. Patient management should aim at eliminating the virus and reducing progression of fibrosis after reinfection. There is no other way to reduce incidence of severe reinfections and associated transplant losses.

Key words: liver transplantation, hepatitis C, reinfection, prophylaxis, immunosuppression

Dr. Marcus Bahra

Klinik für Allgemein-, Viszeral- und Transplantationschirurgie

Charité - Universitätsmedizin Berlin

Campus Virchow-Klinikum

Augustenburger Platz 1

13353 Berlin

E-Mail: marcus.bahra@bitte-keinen-spamcharite.de