Ľubomír Skladaný, Svetlana Adamcová-Selčanová, Jozef Baláž, Erika Čellárová
Liver cirrhosis resulting from chronic hepatitis caused by hepatitis C virus (HCV) infection belongs to frequent indications for liver transplantation (LTx). HCV infection also represents a factor which significantly reduces 5- and 10-year patient survival after LTx in comparison with other, non-malignant indications. Besides the presence of HCV virus, its concentration in serum affects the post-transplant course of the disease. Therefore, possibilities of pre-transplant therapy are investigated. The therapy of patients awaiting LTx still comes up to against many obstacles – high frequency of serious adverse effects, inconsistency of dosing schemes and duration of the therapy, limited achievements of the therapy. A promising but yet not thoroughly investigated therapeutic area is the possibility of using cell growth factors, which might aid in overcoming the prohibitive adverse effects of the antiviral therapy and which could also increase its effectiveness. Infection of the transplanted hepatic graft is inevitable in all patients; viral load is usually higher than before LTx and a considerable part of the patients develop chronic C hepatitis with gradual progression to fibrosis; cirrhosis develops much faster than in the normal population and graft dysfunction and failure represents the most frequent cause of mortality in this group of patients. These are reasons for indicating the therapy after LTx. The concept of pre-emptive therapy initiated shortly after LTx, which was hoped to prevent progression of hepatitis, did not yield expected results and was gradually replaced with the concept of targeted therapy, postponed till the evidence of liver fibrosis. The basic therapeutic protocol is derived from the therapeutic protocols for treating chronic C hepatitis in otherwise normal population, and it includes monitoring the therapeutic effect evaluated by viral response in certain time frames; however, relevance of these indicators is being questioned. Although the effectiveness of antiviral therapy is lower when comparing with the normal population, it represents an unquestionable benefit for the patients after LTx. An exception is the post-transplant cholestatic C hepatitis, which is usually refractory to any treatment.