People with Hepatitis B and – far more commonly – Hepatitis C make up a large number of transplant recipients. The results of liver transplantation for people with Hepatitis B virus with acute or chronic liver failure and/or primary liver cancer have improved greatly, due to advances in antiviral drugs. Following transplantation for Hepatitis B, people are routinely given Hepatitis B immunoglobulin (HBIG) and lamivudine together with other medications, to prevent the virus from re-infecting the new liver.
Hepatitis C (HCV)
In Hepatitis C the new liver is very likely to become re-infected following liver transplantation. Levels of the virus are at their lowest immediately after transplantation but are likely to reach pre-transplant levels (and can be up to twenty times higher) within a few days of the transplant. It is now known that this happens more quickly than in pre-transplant people. This is due to their weakened immune system caused by high doses of immunosuppressant drugs.
Treatment for recurring Hepatitis C is still developing, and doctors have to take great care in prescribing both Hepatitis C and immunosuppressive drugs. Using antiviral drugs following transplant is aimed at stopping rapid viral replication and to limit damage to the liver. This is usually most effective for mild recurrence of infection but the number of people who report side effects is still high. The best timing for giving antiviral medication after transplantation and the most suitable dosages are still being studied bymedical scientists.
As with normal Hepatitis C infection, post-transplant recovery differs between one person and the next. After a few years some people may have persistent viraemia (detectable virus in their blood) with no significant liver damage, while others may have gone on to develop severe fibrosis and cirrhosis.
No single risk factor can be relied on to predict who will go on to develop cirrhosis after transplantation but medical investigation has focused on the following:
- a high viral load at the time of transplantation
- infection with genotype 1 (especially 1b) or 4
- the time between removal of the donor organ and its implantation in the recipient, known as ischemic time
- the age and sex of the donor – studies suggest progression increases with age and is common in women.
Unfortunately one in five people develop cirrhosis within a year of transplant and a small proportion die of Hepatitis C-related liver disease within five years. However, the overwhelming majority of people who survive the transplant will live without serious damage from Hepatitis C virus infection for the first five years.