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- W2005773033 abstract "Hepatitis C virus (HCV) is a leading cause of cirrhosis and hepatocellular carcinoma (HCC) and is the most common in- dication for liver transplantation (LT) in the United States and Europe. In contrast to other indications for LT, HCV re- currence after LT is nearly universal. Death and allograft fail- ure (much of it due to HCV recurrence) are more common in this population versus HCVrecipients 1 (Fig. 1). The nat- ural history of HCV disease is accelerated in the posttrans- plant setting and leads to cirrhosis in 10% to 25% of these patients within 5 to 10 years. 2 Once cirrhosis has developed, complications are common: the rate of decompensated dis- ease is greater than 40% within 1 year, and the survival rate 1 year after decompensation is less than 50%. 2 The delicate immune balance required to prevent both rejection and rapid HCV recurrence remains elusive, and measures to prevent and control recurrent HCV with antiviral therapy have been disappointing. In the future, strategies for eradicating the vi- rus in pre-LT and post-LT settings with novel therapeutics will be crucial to improving outcomes. nosuppression in recent years has been implicated in the lack of improvements in the posttransplant outcomes of HCV patients. In addition, the conclusive diagnosis of rejec- tion in the setting of HCV remains challenging. The treat- ment of acute rejection has been associated with diminished survival in HCV þ recipients but not in HCVrecipients. 7 Because the impact of immunosuppression on HCV recur- rence is most pronounced when high-intensity regimens are used to combat acute rejection, 8-11 mild acute rejection is now treated frequently via the modulation of the baseline immunosuppression without bolus steroids or anti-lympho- cyte antibodies. A recent study also suggested a negative impact of rapid fluctuations in immunosuppression as patients with slow prednisone tapering experienced a lower incidence of severe HCV recurrence at 1 year in comparison with historical controls (29% versus 48%). 12 Steroid-free reg-" @default.
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- W2005773033 date "2012-07-01" @default.
- W2005773033 modified "2023-10-16" @default.
- W2005773033 title "Hepatitis C viral infection after liver transplantation" @default.
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- W2005773033 doi "https://doi.org/10.1002/cld.62" @default.
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