Hepatitis C Virus Infection Among Hematopoietic Cell Transplant Donors and Recipients
Publication Date: August 6, 2015
Last Updated: March 14, 2022
Recommendations
Natural History of HCV Infection in HCT Recipients
In all HCT survivors with active HCV infection, cofactors that can lead to fibrosis should be addressed. Patients should be counseled to avoid excessive weight gain, ethanol and medications or herbal supplements that are hepatotoxic, as well as on treatment of other causes of liver disease (nonalcoholic fatty liver disease, hepatitis B virus, HIV, and extrahepatic obstruction), (CI)
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- and mobilization of excess iron.
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All HCV-infected long-term HCT survivors should be evaluated for progression of liver disease every 6 to 12 months with a hepatic function panel, complete blood cell count, and evaluation of prothrombin time/international normalized ratio. (CI)
If fibrosis is suspected in long-term HCT survivors, noninvasive tests such as serologic panels and transient elastography can be used to evaluate for the presence of advanced fibrosis (Scoring System for Histological Stage Metavir score ≥F3) and cirrhosis (Metavir score F4).
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HCV-infected HCT recipients should be vaccinated against hepatitis A virus and hepatitis B virus following HCT immunization protocols. ()
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Donors and HCT candidates with HCV infection should be counseled to use appropriate precautions to prevent transmission of HCV to others. (CI)
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For HCV-infected HCT long-term survivors with advanced fibrosis (Metavir score ≥F3), surveillance for hepatocellular carcinoma (HCC) with ultrasonography every 6 months is recommended. (CI)
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For patients with cirrhosis, endoscopic surveillance for esophageal varices is recommended. (AI)
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HCT recipients who develop end-stage liver disease can be considered for liver transplant; in rare cases, a living donor liver transplant from the original hematopoietic cell donor may be feasible. (CI)
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Overview
Title
Hepatitis C Virus Infection Among Hematopoietic Cell Transplant Donors and Recipients
Authoring Organization
American Society for Transplantation and Cellular Therapy