Liver transplant
 

Robert Brown MD: Liver transplantation is indicated in patients with hepatitis C only when they develop cirrhosis and its complications or an early hepatocellular carcinoma. Both of these can be treated successfully with liver replacement therapy.

In terms of mortality, there have not been demonstrated differences in the short-term in patients transplanted for hepatitis C and other forms of end-stage liver disease.

In the longer term, we are seeing graft loss and the need for re-transplantation related to hepatitis C recurrence. So I do think that over time, recurrence of hepatitis C is going to be a major problem that we will need to deal with.

Rajender Reddy MD: Hepatitis C infection following liver transplantation invariably recurs in the graft. This has to be kept in mind.

David Bernstein MD: What we're learning is that cirrhosis can recur in patients who are transplanted for chronic hepatitis C. And when it does occur, it tends to recur much more rapidly than initially the development occurred. Meaning, about 10% of patients one year after liver transplantation for hepatitis C will develop cirrhosis again.

Robert Brown MD: There is a lot of interest treating hepatitis C immediately prior to transplantation, with the thought being that if you could eliminate the virus, there wouldn't be recurrence of the hepatitis after transplantation. However, the severe nature of the liver disease and the low blood counts that come with cirrhosis, limit the use of pre-transplant therapy.

Post-transplant therapy is, in general, better-tolerated than pre-transplant therapy, but because of immune suppression, the response rates are lower.