Recurrencia de la infección crónica por el virus de la hepatitis C (VHC) tras el trasplante hepático: factores predictivos de recidiva precoz y grave
SUMMARY. Hepatitis C virus (HCV) infection recurrence after liver transplantation: prognostic factors for early and severe recurrence. HCV recurrence after liver transplantation (LT) is almost universal. HCV-related liver disease progresses more rapidly after liver transplantation than in immunocompetent individuals. Thus, survival after LT is also lower in these patients compared to other groups. -HCV virus kinetics during and immediately after LT. This study demonstrated a sharp decrease in viral load during the anhepatic phase and reperfusion, most likely owing to a lack of virions production and hepatic clearance.However, HCV-RNA is detectable during almost all the surgical procedure and circulating virions are supposed to cause graft infection.Viral replication begins immediately after graft reperfusion as demonstrated by the rapid increase in viral load during the first days after transplantation. -Efficacy and safety of antiviral therapy in HCV-cirrhotic patiens awaiting liver transplantation. One of the strategies that may avoid HCV-recurrence after LT is to erradicate viral infection before the surgery. Antiviral therapy is contraindicated in decompensated cirrhotic patients because its relative low efficacy and high risk of adverse events. However, we have demonstrated that an accurate selection and follow up of patients can lead to a succesful outcome in 30% of them (HCV-negativization during treatment). HCV-recurrence after LT was avoided in 20% of patients. -HCV-recurrence after living donor and cadaveric donor liver transplantation. In this prospective study we observed that HCV recurrence was significantly more severe in living donor liver transplantation compared to cadaveric liver transplantation.Type of donor (living vs cadaveric) was an independent prognostic factor for severe HCV-recurrence. Biliary complications and liver regeneration may play a role in this more severe outcome of HCV recurrence after living donor liver transplantation.These results should be taken into account in the decission-making process of transplant programs, since severe HCV-recurrence may ultimately compromise graft and patient survival.
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Advisor:Arroyo Pérez, Vicente; Forns Bernhardt, Xavier
School:Universitat de Barcelona
Source Type:Master's Thesis
Date of Publication:06/09/2005