Hepatitis C virus (HCV) has become the leading cause for orthotopic liver transplantation (OLT) worldwide. OLT for HCV has been associated with good survival outcomes. HCV recurrence has been universally documented in allograft recipients within the 1st year post-transplantation. Slow but steady progression of recurrent disease has resulted in allograft failure in a small number of patients in the short-term and may cause allograft destruction in a larger number of patients in the long-term. A pressing need has therefore developed to identify antiviral regimens to treat or prevent recurrent disease. Unfortunately, current antiviral therapy has limited efficacy and is associated with multiple adverse events. Therefore, a concerted effort has been directed toward identification of the patient populations who are most susceptible to the deleterious effects of recurrent disease or those who are most likely to benefit from antiviral treatment. These patient populations may therefore be selected for antiviral therapeutic intervention. Unsuccessful antiviral therapy or the development of allograft may be an indication for retransplantation (re-OLT), a procedure that is not widely accepted since it is associated with high morbidity and mortality. Nevertheless, the appropriate and timely utilization of re-OLT may achieve good results in selected patients. This chapter will outline the current understanding and the results of medical and surgical therapeutic options for recurrent HCV following OLT.
