Natural history of recurrent hepatitis C

1. After liver transplantation for hepatitis C virus (HCV)-related cirrhosis, recurrence of infection is universal, with development of histological hepatitis in the majority of patients. 2. The natural history of recurrent hepatitis C is highly variable. Although 30% to 50% of patients develop posttransplantation viremia with minimal liver injury, 10% to 30% progress to cirrhosis after a median of 5 years. 3. Progression of hepatitis C is accelerated in immuno-compromised liver transplant recipients compared with immunocompetent patients, both before and after the development of compensated cirrhosis. 4. HCV-related disease progression is faster in patients who underwent transplantation in recent years compared with those who underwent transplantation earlier. 5. HCV infection significantly impairs patient and allograft survival after liver transplantation. 6. Several variables, including donor age, degree of immunosuppression, viral load either pretransplantation or early posttransplantation, timing of recurrence, and early histological findings, are implicated in the outcome of hepatitis C posttransplantation.