Hepatitis C (cont.)
Siddharth Bansal, MD
Ashwani Singal, MD, MS, FACG
In this Article
Hepatitis C and liver transplantation
Hepatitis C is the leading reason for liver transplantation in the U.S., accounting for 40% to 45% of transplants. Hepatitis C routinely recurs after transplantation and infects the new liver. Approximately 25% of these patients with recurrent hepatitis will develop cirrhosis within five years of transplantation. Despite these findings of recurrence, the five-year survival rate for patients with hepatitis C is comparable to that of patients who are transplanted for other types of liver disease.
Treatment for recurrent hepatitis after transplantation is not a simple issue. Most transplant centers delay therapy until recurrent disease is confirmed. Treatment of recurrent hepatitis has been complicated since interferon, an important drug for treatment until now, is an immune modulator (modifier) that may promote rejection of the transplanted liver. Furthermore, interferon and ribavirin may not be well tolerated by patients who have recently undergone transplantation and are taking many different kinds of medications that might interact. Hence, interferon based regimens no longer are recommended.
Oral, highly effective, direct acting antivirals have again showed encouraging results in patients who have undergone liver transplantation for hepatitis C infection. Combinations of ledipasvir and sofosbuvir (Harvoni) along with Ribavirin have shown high cure rates (above 90%) for hepatitis C in patients without cirrhosis after transplantation of the liver, although in patients not tolerating ribavirin the cure rate drops to approximately 75%. On other hand, in patients with advanced cirrhosis, options change to a combination of sofosbuvir (Sovaldi) and ribavirin. Again choice of therapy needs to be individualized and is different for different genotypes.
How is monitoring done before, during and after treatment?
Prior to treatment, doctors will determine if there is a risk of interaction of medications used for treating hepatitis C with other medications the patient is taking. The viral load and HCV genotype will be obtained to guide the therapy.
Tests that may be ordered by the doctor to monitor patients undergoing hep C treatment, or have completed hep C treatment include:
During the therapy, frequent monitoring will be done with the same blood tests approximately every four weeks. Any significant abnormality may indicate medication side effects, and might require decreasing or discontinuing the medication. Women of child bearing age and female partners of males who are receiving ribavirin also may be monitored with for possible pregnancy with pregnancy tests.
Once patients successfully complete the treatment, the viral load will be to establish if there is a cure. If cure is achieved (undetectable viral load after treatment), no further additional testing is recommended in the absence of cirrhosis. In the presence of cirrhosis, twice-yearly ultrasound testing will be required to check for development of liver cancer along with endoscopy to look for other signs of cirrhosis.
For patients who failed to achieve cure, progression of the disease will be assessed every 6 to 12 months with a blood counts, liver and coagulation tests, along with twice-yearly ultrasound examination of the liver to check for the development of liver cancer.
Medically Reviewed by a Doctor on 5/26/2015
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