Recurrent hepatitis C after liver transplantation.

The pathogenesis of aggressive liver injury in patients with severe disease requiring retransplantation is not well understood, although genotype and type and degree of immunosuppression and rejection episodes may be important. Nevertheless, our understanding of recurrent hepatitis C after transplantation is rapidly evolving, and effective treatment with interferon and ribavirin may be available in the near future. In this sense, the situation is reminiscent of transplantation for hepatitis B 10 years ago. A number of retransplants were performed for severe recurrent disease before it was appreciated how futile this was. It was not until HBIG was shown to be effective in preventing severe recurrent disease that a major impact on this serious problem was achieved. Further advances in the care of patients undergoing transplantation for hepatitis C will result from enhanced understanding of hepatitis C, more cautious treatment of these patients with immunosuppression, and effective treatment for severe recurrent hepatitis C after liver transplantation. It will not come from retransplantation in these unfortunate individuals.