GASTROENTEROLOGY ARTICLE OF THE WEEK

May 10, 2001

 Szabo G, Katz E, Bonkovsky HL.  Management of recurrent hepatitis C after liver transplantation:  A concise review.  Am J Gastroenterol 2000;95:2164-2170.

 1.  Hepatitis C infection after liver transplantation

            a.  recurs in only 50% to 60% of patients

            b.  viremia is detectable during the first month after transplant

            c.  progression of disease is faster than in non-transplanted patients

d.  decreases the 2 and 5 year survival rate compared to those transplanted for other causes.

 True or False

 2.  Treatment with ribavirin alone results in improvement in transaminases but no change in histopathologic severity of the hepatitis, none of the patients cleared virus.

 3.  Combination therapy with interferon and ribavirin appears to offer the greatest likelihood of viral suppression/elimination and histologic improvement.

4.  Pretransplant genotype is related to the severity of post-transplant liver injury

 5.  High GGTP and bilirubin levels are associated with a lower likelihood of response to antiviral therapy.

 6.  Interferon therapy increases the risk of liver rejection.

 7.  Interferon monotherapy is unable to achieve viral eradication in post-transplant patients.

 8.  Prophylactic therapy with antivirals soon after transplantation

            a.  may prevent re-infection of the graft

b.  is associated with a higher risk of rejection, as it must be started soon post transplant

            c.  decreases post transplant quality of life and recovery

            d.  prevents re-infection in the majority of cases

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