ABSTRACT
BACKGROUND: A management protocol for hepatitis C virus (HCV) after liver transplantation (LT) has not been established in Korea. We therefore investigated HCV transplant protocols and post-transplant results from liver transplant centers in Korea. METHODS: The HCV protocol and medical data of individual cases from eight major liver transplant centers were compiled and analyzed. RESULTS: A post-transplant protocol biopsy was performed in only three centers. In these centers, HCV treatment was considered when pathological abnormalities were confirmed on the protocol biopsy (irrespective of liver function). In the other five centers, biopsies were performed when biochemical parameters were aggravated. Only two out of the eight centers performed preemptive or prophylactic therapy. A total of 5,663 adult LTs were performed between 2000 and 2010. HCV-related liver disease was responsible for 277 LTs (4.9%). Pre-transplant data were not available in many patients, including HCV genotype and serum HCV RNA level. Tacrolimus was more frequently used for initial maintenance immunosuppression than cyclosporine A (61.7% vs. 36.8%). Post-transplant HCV treatment was performed in 135 patients (48.7%). Sixty-seven recipients (24.2%) died during follow-up after LT and 11 HCV-related graft loss (4.0%) developed. The cumulative patient survival rate was 74.7% at 5 years and 67.9% at 10 years after LT. CONCLUSIONS: The HCV management protocol after LT varied markedly between the eight Korean transplant centers and a standard protocol did not exist. A nationwide multicenter study is required to investigate the most effective treatment for HCV after LT, with the goal of establishing the most effective standard protocol.
Subject(s)
Adult , Humans , Biopsy , Cyclosporine , Follow-Up Studies , Genotype , Hepacivirus , Hepatitis , Hepatitis C , Immunosuppression Therapy , Korea , Liver , Liver Diseases , Liver Transplantation , RNA , Survival Rate , Tacrolimus , TransplantsABSTRACT
Different degrees of HCV re-infection exist in patients with hepatitis C after liver transplantation. Its pathogenesis is different according to different phases of the disease. Factors affecting its recurrence include HCV gene type, viral load, HLA matching between donor and recipient, time of recurrence, donor's age and so on, in which the application of immunosuppressants is the most important influencing factor. The virological response can be used to evaluate the effects of treatment. Now, it is widely accepted that the best choice and therapeutic plan is Pegy interferon alfa-2a/2b combined with Ribavirin.