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Treating HCV After Liver Transplantation

Chapter

Abstract

Hepatitis C-related liver disease remains the number one indication for liver transplantation in the United States, and recurrent hepatitis C infection after liver transplantation approaches 100%. The past experiences in the management of recurrent hepatitis C have led to the current recommended anti-viral treatment with ribavirin and pegylated interferon. In this chapter we address the past, present, and future therapies and treatment strategies for recurrent hepatitis C after liver transplantation. The particular focus addresses current therapy, including monitoring for recurrence, timing of treatment, anti-viral dosing, adjuvant therapy with epogen analogs and granulocyte-stimulating factor, identifying factors influencing response to therapy, patient outcomes, and cost effectiveness of therapy. Also addressed in this chapter are special considerations in patients with viral co-infection with human immunodeficiency virus (HIV) or cytomegalovirus (CMV), as well as the possibility of treating patients who fail anti-viral therapy, and liver retransplantation for recurrent cirrhosis. Future therapies for hepatitis C remain an intense area of research, particularly the use of protease inhibitors (telaprevir and boceprevir) in conjunction with pegylated interferon and ribavirin; however, there are special considerations for liver transplant patients, and their effectiveness among this population remains to be observed.

Keywords

Hepatitis C recurrence Liver transplantation Antiviral therapy 

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© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of MedicineUniversity of California at Los AngelesLos AngelesUSA
  2. 2.Department of Surgery, Pfleger Liver InstituteUniversity of California at Los AngelesLos AngelesUSA

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