Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

End stage liver disease due to hepatitis C virus (HCV) infection is the most common indication for liver transplantation (LT) worldwide. Regretfully, infection of the graft by HCV occurs almost universally after LT, causing chronic hepatitis and early progression to cirrhosis in a significant proportion of recipients. Moreover, graft and patient survival are significantly worse in patients undergoing LT for HCV-related cirrhosis than in those transplanted for other indications. Therefore, many LT centers consider antiviral treatment with interferon and ribavirin the mainstay of managing recurrent HCV disease in LT recipients. The optimal time to start treatment is unclear. In most instances, treatment is initiated when histological evidence of disease recurrence, either at protocol or on-demand liver biopsies, is observed after LT. However, antiviral treatment initiated before LT is a potential option for some patients for two reasons: first, clearing or suppressing HCV before LT may reduce or eliminate the risk of recurrent hepatitis C in the transplanted liver and thereby improve survival; second, clearing HCV in cirrhotic patient may halt disease progression and avoid the need for transplantation. In this article, the results obtained by pre-transplant antiviral regimens administered to HCV-positive cirrhotic patients awaiting LT are discussed.
 ...
PMID:Antiviral treatment in patients with hepatitis C virus-related cirrhosis awaiting liver transplantation. 1882 55

End stage liver disease from hepatitis C is the leading indication for liver transplantation (LT) in the United States. Recurrent hepatitis C after LT is universal and causes substantial morbidity and mortality with up to 30% patients developing cirrhosis by the fifth postoperative year. Once cirrhosis is established, the risk of hepatic decompensation is approximately 40% per year. Risk factors associated with accelerated disease recurrence are elevated high viral load prior to transplantation, older donor age, prolonged ischemic time, cytomegalovirus coinfection, intensity of immunosuppression and HIV coinfection. Although the mechanisms of accelerated HCV-induced liver damage after transplantation are poorly understood, strategies employed to limit severe recurrence include avoidance of older donors, early recognition of cytomegalovirus, minimization of immunosuppression, particularly T-cell depleting therapies and pulsed steroids for acute cellular rejection. Treatment of recurrent hepatitis C post-transplant is also problematic and fraught with controversy. As there is a paucity of evidence on when treatment should be initiated, out of necessity treatment has been empiric and often varies between centers. As prophylactic treatment immediately after transplantation is rarely effective and associated with numerous side effects, most clinicians acknowledge that treatment should be initiated once early fibrosis has developed although sustained viral rates with pegylated interferon and ribavirin are frequently less than 30%. Side effects are common and can lead to dose reduction or discontinuation of treatment. For those patients who develop develop decompensated cirrhosis from recurrent hepatitis C, retransplantation may be considered.
 ...
PMID:Hepatitis C recurrence after liver transplantation. 2019 34

End stage liver disease from hepatitis C is the most common indication for liver transplantation in many parts of the world accounting for up to 40% of liver transplants. Antiviral therapy either before or after liver transplantation is challenging due to side effects and lower efficacy in patients with cirrhosis and liver transplant recipients, as well as from drug interactions with immunosuppressants. Factors that may affect recurrent hepatitis C include donor age, immunosuppression, IL28B genotype, cytomegalovirus infection, and metabolic syndrome. Older donor age has persistently been shown to have the greatest impact on recurrent hepatitis C. After liver transplantation, distinguishing recurrent hepatitis C from acute cellular rejection may be difficult, although the development of molecular markers may help in making the correct diagnosis. The advent of interferon free regimens with direct acting antiviral agents that include NS3/4A protease inhibitors, NS5B polymerase inhibitors and NS5A inhibitors holds great promise in improving outcomes for liver transplant candidates and recipients.
...
PMID:Recurrent hepatitis C after liver transplant. 2515 71