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Semin Gastrointest Dis 1998 Jul;9(3):86-109
Recurrent disease after liver transplantation.
Davern TJ, Lake JR
Department of Medicine, University of California, San Francisco 94143-0538,
USA.
Most liver diseases for which liver transplantation is performed recur after
liver transplantation. The clinical impact of recurrence varies. For autoimmune
liver diseases, such as primary biliary cirrhosis, primary sclerosing cholangitis,
and autoimmune hepatitis, clinically significant recurrence appears to be relatively
rare. Whether these diseases recur in any meaningful way after liver transplantation
is still controversial. For the chronic viral diseases, hepatitis B and C, the
issue is not whether they recur--they clearly do--but whether the recurrence
affects prognosis and how best to manage recurrent disease. For hepatitis B
virus (HBV), reinfection can lead to accelerated liver injury, graft loss, and
dramatically worse patient and graft survival rates, whereas the prognosis of
recurrent hepatitis C virus (HCV), at least in the short-term, appears to be
more benign. Major advances have been made in preventing liver allograft reinfection
with HBV. Before these advances, chronic hepatitis B was considered a relative
contraindication to liver transplantation because the allografts almost always
became reinfected. With the current strategies for preventing HBV reinfection,
however, the graft and patient survival rates after transplantation for chronic
hepatitis B approach those for nonviral diseases. The development of resistance
to antiviral therapy is likely to represent the major problem in the future
and mandate the use of combination therapy. There is currently no effective
therapy available for recurrent hepatitis C. Until such therapy is developed,
recurrent hepatitis C remains the most challenging problem facing liver transplant
physicians and surgeons.
PMID: 9700841, UI: 98366199
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