Monitoring hepatitis C infection in the liver allograft.

Chronic hepatitis C virus (HCV) infection-induced end-stage liver disease is the leading indication for liver transplantation and, in 2011, accounted for 1364 (23.5%) liver transplants performed in the United States. Treatment options for HCV are rapidly evolving, with realistic expectations of being able to cure the majority of patients in the very near future before the need for for transplantation arises. Until such time, the status quo we are faced with is a large cohort of HCV cirrhosis patients who will require salvage with liver transplantation. The difficulty with hepatitis C post-transplantation is that reinfection of the allograft is virtually universal. Reinfection occurs with a wide range of clinical presentations ranging from the most severe form, fibrosing cholestatic hepatitis, which occurs very early after transplantation and invariably leads to early graft failure and a possible need for retransplantation or death, to a milder but still aggressive course in the majority of patients leading to bridging fibrosis and cirrhosis. The rate at which this develops is approximately 30% to 50% at five years without antiviral treatment (1). An essential element of managing post-transplant hepatitis C is to detect individuals who are at risk of progression at an early stage, defined by most studies as a Metavir score ≥2, and commence antiviral treatment (1).