Ciria Ruben, Pleguezuelo María, Khorsandi Shirin Elizabeth, Davila Diego, Suddle Abid, Vilca-Melendez Hector, Rufian Sebastian, de la Mata Manuel, Briceño Javier, Cillero Pedro López, Heaton Nigel
Ruben Ciria, Shirin Elizabeth Khorsandi, Diego Davila, Abid Suddle, Hector Vilca-Melendez, Nigel Heaton, Institute of Liver Studies, King's College Hospital, London SE5 9RS, United Kingdom.
World J Hepatol. 2013 May 27;5(5):237-50. doi: 10.4254/wjh.v5.i5.237.
Hepatitis C virus (HCV) is a major health problem that leads to chronic hepatitis, cirrhosis and hepatocellular carcinoma, being the most frequent indication for liver transplantation in several countries. Unfortunately, HCV re-infects the liver graft almost invariably following reperfusion, with an accelerated history of recurrence, leading to 10%-30% of patients progressing to cirrhosis within 5 years of transplantation. In this sense, some groups have even advocated for not re-transplanting this patients, as lower patient and graft outcomes have been reported. However, the management of HCV recurrence is being optimized and several strategies to reduce post-transplant recurrence could improve outcomes, decrease the rate of re-transplantation and optimize the use of available grafts. Three moments may be the focus of potential actions in order to decrease the impact of viral recurrence: the pre-transplant moment, the transplant environment and the post-transplant management. In the pre-transplant setting, it is not well established if reducing the pre transplant viral load affects the risk for HCV progression after transplant. Obviously, antiviral treatment can render the patient HCV RNA negative post transplant but the long-term benefit has not yet been fully established to justify the cost and clinical risk. In the transplant moment, factors as donor age, cold ischemia time, graft steatosis and ischemia/reperfusion injury may lead to a higher and more aggressive viral recurrence. After the transplant, discussion about immunosuppression and the moment to start the treatment (prophylactic, pre-emptive or once-confirmed) together with new antiviral drugs are of interest. This review aims to help clinicians have a global overview of post-transplant HCV recurrence and strategies to reduce its impact on our patients.
丙型肝炎病毒（HCV）是一个重大的健康问题，可导致慢性肝炎、肝硬化和肝细胞癌，是多个国家肝移植最常见的适应证。不幸的是，HCV几乎总会在再灌注后重新感染肝移植移植物，复发进程加速，导致10% - 30%的患者在移植后5年内发展为肝硬化。从这个意义上说，一些团体甚至主张不再对这些患者进行再次移植，因为据报道患者和移植物的预后较差。然而，HCV复发的管理正在优化，一些减少移植后复发的策略可能会改善预后、降低再次移植率并优化可用移植物的使用。为了降低病毒复发的影响，三个阶段可能是潜在行动的重点：移植前阶段、移植环境和移植后管理。在移植前阶段，降低移植前病毒载量是否会影响移植后HCV进展的风险尚未明确。显然，抗病毒治疗可使患者移植后HCV RNA呈阴性，但长期益处尚未完全确立，无法证明成本和临床风险的合理性。在移植阶段，供体年龄、冷缺血时间、移植物脂肪变性和缺血/再灌注损伤等因素可能导致更高且更具侵袭性的病毒复发。移植后，关于免疫抑制以及开始治疗的时机（预防性、抢先性或确诊后）以及新型抗病毒药物的讨论备受关注。本综述旨在帮助临床医生全面了解移植后HCV复发情况以及降低其对患者影响的策略。
