The review discusses whether antiviral therapy for recurrent hepatitis C virus (HCV) infection may be used following liver transplantation. It analyzes the concepts of pre-emptive therapy initiated within the first weeks after the transplantation, as well as therapy for histologically verified active hepatitis and/or liver fibrosis. Capabilities and limits in the use of pegylated interferons and ribavirin as monotherapy or combination therapy are considered. Particular emphasis is placed on the role of viral kinetics in the determination of the duration of further therapy, including the possibility of its prolongation up to > 12 months. There are arguments in favor of a better course of recurrent HCV infection in patients receiving cyclosporine versus those taking tacrolimus.

The paper describes a case of posttransplantation fibrosing cholestatic hepatitis C (PFCHC) in a female patient whose transplant was preserved due to timely antiviral therapy (AVT). Its differential diagnosis primarily required that chronic graft rejection and biliary anastomotic stricture be excluded as a cause of dysfunction. PFCHC was proposed to be a possible cause of graft dysfunction on the basis of the clinical course of the disease, the presence of a very high viral load, intervals after orthotopic liver transplantation, the results of histological studies, and no signs of biliary hypertension. Antiviral monotherapy was initiated using pegylated interferon α-2a (Pegasys), which resulted in a considerable improvement and yielded complete early virological and biochemical responses to AVT. This allows one to hope to obtain a sustained virological response and to eliminate hepatitis C infection in the patient after termination of a 48-week course of therapy.

This article presents a three-year experience with mTOR inhibitors in the schemes of immunosuppressive therapy in patients post liver transplantation.

An experience of the Moscow Center for Liver Transplantation in the field of antiviral therapy of hepatitis C in recipients of liver grafts has been analyzed. From 2002 to 2012 forty nine courses of treatment were initiated in 42 patients. Eradication of infection caused by the hepatitis C virus (HCV) was achieved in 42% patients who received at least one dose of drugs, and in 56% patients who received at least 80% of doses of drugs for more than 80% of the planned duration of therapy. The rate of decrease of HCV viremia during antiviral therapy in liver transplant recipients is slower than in immunocompetent patients, and this fact justifies the need for a more long-term treatment. Accounting for pharmacogenetic indicators prior to antiviral therapy is able to predict the rate of decline in viremia HCV. The main complication of antiviral therapy after liver transplantation was cytopenia. The use of erythropoietin and filgrastim throughout the whole course of therapy allowed to maintain therapeutic doses of antiviral drugs and did not lead to serious adverse events.

The results of 21 courses of antiviral therapy (AT) in 18 pts with HCV infection after cadaveric liver transplan- tation have been analyzed. (One recipient received AT twice due to noncompliance and two patients re-started AT PEG-IFN monotherapy). AT included PEG–IFN alpha-2a (180 mcg/w) in 18 cases or PEG-IFN alpha-2b (1,5 mcg/kg/w) in 3 cases combined with RBV (9,9 (3,3) mg/kg/day). Since 2008 epoetin-alfa (30,000 U/w) and fi lgrastim (300 mcg/w) were added to correct cytopenias for all treatment duration. Sustained virologic response was achieved in 25% cases (ITT) or in 40% cases (completed 80/80/80 rule per protocol). Rapid virologic res- ponse occurred only in 2 patients with non-1 genotype HCV with respectively low viral load, and complete early virologic response (EVR) – in 10 (56%) of 18 patients. Complete EVR occurred in all non-1 genotype pts, but only in 5/13 pts with HCV genotype 1 (p = 0,036). Four pts achieved negative serum HCV RNA post 12 week of AT. The early viral dynamic is slower in AT of recurrent HCV infection in liver transplant recipients than in non-transplanted patients. Growth factors can safely and effectively be used in complex treatment of hepatitis C after liver transplantation.

To compare clinical and virologic course of de novo and recurrent HBV infection 104 liver graft recipients with 6 months and more follow-up after cadaveric transplantation have been analyzed. Recurred HBV infection occurred in 7 (30.4%) out of 23 HBsAg-positive and de novo HBV infection – in 11 out of 81 (13.6%) HBsAg- negative recipients. HBeAg and IgM anti-HBc appeared in 8 recipients with de novo and in one case – with recurrent infection. Two recipients with de novo HBV developed acute hepatitis with jaundice and one – chronic hepatitis with graft cirrhosis. Only one recipient with recurrent HBV developed severe acute hepatitis HBV/ HDV, with anti-HBs seroconversion after 12 weeks of peginterferon alfa treatment. Nucleoside analogs (NA) were started in all 11 de novo HBV cases and in 5 cases of recurrent HBV infection. Treatment with NA effec- tively suppressed HBV DNA replication in both recurrent and de novo infections; HBsAg clearance occurred in 64% of de novo HBV and in 20% – of recurrent HBV cases. No secondary drug resistance occurred. De novo HBV infection is a self-limited disease in most cases, and preemptive NA treatment is the best treatment choice. Recurrent HBV infection is usually chronic, and pegylated interferon may be under consideration as well as NA.

It is presented data on the formation of waiting lists for patients who are scheduled liver transplantation. Indications, contraindications, preparations for the implementation of a liver transplant, an immune suppression construction, observed postoperative complications are detailed.