Liver transplant for viral hepatitis and fulminant hepatic failure

Abstract

Since the introduction of hepatitis B immunoglobulin and nucleoside/nucleotide antivirals in the 1990's, outcomes of LT for hepatitis B virus (HBV)-related liver disease, regardless of whether for decompensated cirrhosis, hepatocellular carcinoma satisfying Milan criteria or fulminant hepatic failure (FHF), have been favorable with results comparable if not better to other liver transplant recipients. Unfortunately the same optimism does not hold true for hepatitis C which differs from post- transplant hepatitis B in many ways, most striking of which are the limited options for treatment of recurrent hepatitis C (HCV). As time has passed, the initial enthusiasm for liver transplantation for HCV has waned as the original excellent five year survival rates have now translated into disappointing medium- and long-term survival data. Cirrhosis can also develop in between 10-25% of patients by five years post-transplant which in turn has led to recurrent HCV-related cirrhosis emerging as an important yet controversial indication for retransplantation. A variety of diseases can cause FHF with drug-related hepatotoxicity, particularly from acetaminophen accounting for 50-60% of cases in United Kingdom and the United States while viral hepatitis appears to be declining as a cause. Although FHF is a relatively rare disease affecting approximately 2000 patients per year in the United States, it is associated with high morbidity and mortality without transplantation yet only 25% of patients in the United States undergo liver transplantation. This review article will discuss liver transplantation for HBV and HCV and will conclude with reviewing the etiology, epidemiology and management of FHF.