Untreated rHCV may progress with necroinflammation, leading to allograft injury and fibrosis. essential in the management of post-LT or recurrent infections. Optimising immunosuppression is an important step in reducing the severity of allograft damage in the treatment of post-transplant viral infections. Viral clearance or control can be achieved by early initiation of high potency antiviral therapy. infection, Recurrent viral contamination, Hepatitis B, Hepatitis C, COVID-19, Hepatitis E, CMV, EBV, HSV, HHV-6 Introduction Liver transplantation (LT) is the only curative therapy for patients with decompensated cirrhosis, with an one year and 5-12 months survival of around 90% and 70%, respectively [1]. Survival following LT has improved over the years from a 1 and 5 12 months survival of 70% and 50%, to 90% and 70%, respectively. Significant improvement in surgical techniques, peri-operative care and immunosuppression therapy has translated in to better survival. However, increasing complexity of patients selection and growth of indications for liver transplantation may influence post-transplant outcomes. Optimal immunosuppression is essential to maintain the balance between rejection and contamination in the post-transplant period. Recurrent viral contamination in the post-transplant has been a major obstacle in the previous era causing severe allograft dysfunction leading to graft failure and death. There exists a wide geographical heterogeneity in the burden of chronic liver disease (CLD) across the globe, which may influence the indication and end Naltrexone HCl result of LT. Around 350 million people are affected by Hepatitis B contamination (HBV) worldwide, with a higher prevalence in Asia and Africa (0.7C22.3%) compared to the West [2]. Similarly, around 200 million people suffer from chronic hepatitis C contamination (HCV) globally, more common in central Asia and Japan [3]. Approximately, 80% of HCV infected patients develop chronic liver disease and 16C20% patients develop cirrhosis over 20 years depending on the host, viral and environmental factors [4]. Hepatic decompensation occurs in 3C6% annually and 15C20% in these patients over 3C5 years [4,5]. Chronic Hepatitis C contamination is the most common indications for liver Naltrexone HCl transplantation around the world. Considering the long term immunosuppressive state, post-transplant patients are at a significant risk of infection could be environmental or donor derived at the time of transplantation. In addition, there remains a significant risk of disease reactivation leading to recurrence particularly in patients transplanted for viral hepatitis. Development of or recurrent viral hepatitis can damage the liver allograft leading to a considerable impairment of graft and individual survival. Understanding the natural history of Rabbit polyclonal to ZNF500 viral hepatitis in the LT recipients and the development of antiviral therapy has changed long term survival of these patients remarkably. In this review, we focus on the prevalence, natural history and clinical outcomes of hepatitis C (rHCV), hepatitis B (rHBV), HEV and other viral infections such as CMV, HSV and EBV in LT recipients. In addition, given the current COVID-19 pandemic, we discuss impact of SARS-CoV-2 in the liver allograft and their outcomes. Hepatitis C Recurrent Hepatitis C (rHCV) contamination of the liver allograft is universal in untreated patients transplanted for this indication. Allograft colonisation by viral particles occurs at the time of portal reperfusion inducing liver damage as early as 72?hours post-LT. A study on HCV viral kinetics exhibited an initial sharp decline in the RNA levels within 24?h of reperfusion followed by a rapid increase to nearly 20 fold higher than the pre-transplant values during the first week [6]. Untreated rHCV may progress with necroinflammation, leading to allograft injury and fibrosis. In a study to evaluate the natural course of 183 HCV liver transplanted patients using protocol liver biopsies, fibrosis score progressed from 1.2 to 2.2 over a 10 12 months period. Post-LT patients with severe fibrosis at 1 year due to rHCV were associated with poor survival. Furthermore, donor age 33 years and HCV genotype 1 or 4 developed were associated with quick fibrosis Naltrexone HCl [7]. Post-transplant immunosuppression accelerates rHCV related liver damage with fibrosis progression at the rate of 0.3%C0.8% per year leading to cirrhosis and graft loss in 20C40% of patients within 5 years [8,9]..