Récidive de la maladie initiale

Since rejection has become better controlled, recurrence of the initial disease on the graft is the most important problem after liver transplantation. Recurrence of the initial disease has been established for the B and C hepatitis and the hepatocellular carcinoma. The diagnosis of recurrence of biliary and auto-immune diseases is difficult and depends on a series of arguments. Hepatitis B recurrence is prevented by injection of anti-HBs immunoglobulin and anti viral therapy whereas hepatitis C is more hardly controlled. The period preceding liver transplantation is the moment of choice to limit the risk of recurrence, by treating the hepatitis C and confirming alcohol abstinence. Optimised management of the alcoholic disease allows decreasing its recurrence. The treatment of hepatitis C recurrence after liver transplantation is under evaluation. The ideal immunosuppression to limit recurrences of hepatitis C and biliary and auto-immune diseases is not currently known. In some cases, the only treatment is re-transplantation.