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Am J Transplant. 2009 Aug;9(8):1707-13. doi: 10.1111/j.1600-6143.2009.02702.x. Epub 2009 Jun 16.

A practical guide to the management of HCV infection following liver transplantation.

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  • 1Department of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, MN, USA.

Abstract

Hepatitis C-associated liver failure is the most common indication for liver transplantation, with virological recurrence near ubiquitous. Approximately 30% of HCV-infected recipients will die or lose their allograft or develop cirrhosis secondary to hepatitis C recurrence by the fifth postoperative year, with the proportion increasing with duration of follow-up. Strategies for minimizing the frequency of severe HCV recurrence include avoidance of older donors, early diagnosis/treatment of CMV and minimization of immunosuppression, particularly T-cell depleting therapies and pulsed corticosteroid treatment of acute cellular rejection. Patients should be offered treatment with peginterferon and ribavirin before LT if MELD </= 17 or as soon as histological evidence of recurrence of HCV is apparent post-LT. Because of the high frequency of hemotoxicity and renal insufficiency, ribavirin should be dosed according to renal function.

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