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103-412: HEPC may refer to: Hepatitis C , a disease Hepcidin , a peptide hormone Hydrogenated egg phosphatidylcholine Haryana Environment Protection Council , India Topics referred to by the same term [REDACTED] This disambiguation page lists articles associated with the title HEPC . If an internal link led you here, you may wish to change

206-533: A 2021 report that 58 million people globally were living with chronic hepatitis C as of 2019. About 1.5 million people are infected per year, and about 290,000 people die yearly from hepatitis C–related diseases, mainly from liver cancer and cirrhosis. Hepatitis C infection rates increased substantially in the 20th century due to a combination of intravenous drug abuse and the reuse of poorly sterilized medical equipment. However, advancements in treatment have led to notable declines in chronic infections and deaths from

309-444: A combination of pegylated interferon alpha and ribavirin for a period of 24 or 48 weeks, depending on HCV genotype . This treatment produces cure rates of 70–80% for genotype 2 and 3, respectively, and 45–70% for genotypes 1 and 4. Adverse effects with these treatments were common, with 50–60% of those being treated experiencing flu-like symptoms and nearly a third experiencing depression or other emotional issues. Treatment during

412-446: A decompensating event such as hepatic encephalopathy , variceal bleeding , ascites , or spontaneous bacterial peritonitis may also signal a new need for a liver transplant. Although liver transplantation is the most effective treatment for many forms of end-stage liver disease, the tremendous limitation in allograft (donor) availability and widely variable post-surgical outcomes make case selection critically important. Assessment of

515-508: A decreased temperature (usually 4 degrees Celsius) to slow down anaerobic metabolic breakdown. An alternative method involves machine perfusion, in which oxygenated, preservation solutions are continually pumped through the liver prior to transplantation. This is currently being investigated with cold (hypothermic), body temperature (normothermic), and under body temperature (subnormothermic) preservation solutions. Hypothermic machine perfusion has been used successfully at Columbia University and at

618-448: A liver transplant recipient and its impact on the graft. The research, conducted by Hannolainen et al., utilized hybrid capture sequencing and various molecular techniques to analyze the viral sequences and host immune response. The findings demonstrated active replication of iciHHV-6B within the graft tissue and significant immune activation, suggesting the pathological impact of viral reactivation on transplant outcomes. The study highlights

721-401: A liver transplant will be rejected by the recipient unless immunosuppressive drugs are used. The immunosuppressive regimens for all solid organ transplants are fairly similar, and a variety of agents are now available. Most liver transplant recipients receive corticosteroids plus a calcineurin inhibitor such as tacrolimus or ciclosporin , (also spelled cyclosporine and cyclosporin) plus

824-409: A machine to pump blood through the explanted liver (after it is harvested from the body) during a transfer have met some success ( see Research section for more ). Living donor liver transplantation (LDLT) has emerged in recent decades as a critical surgical option for patients with end stage liver disease, such as cirrhosis and/or hepatocellular carcinoma often attributable to one or more of

927-624: A person initially deemed "transplant-ineligible" may later become a favorable candidate if the circumstances change. Some examples include: Other conditions, including hemodynamic instability requiring vasopressor support, large liver cancers or those with invasion to blood vessels, intrahepatic cholangiocarcinoma , frailty , fulminant liver failure with suspected brain injury, alcohol use disorder with recent alcohol consumption, cigarette smoking, inadequate social support, and nonadherence to medical management may disqualify someone from liver transplantation, however these cases are usually evaluated by

1030-554: A person's transplant eligibility is made by a multi-disciplinary team that includes surgeons, medical doctors, psychologists and other providers. The first step in evaluation is to determine whether the patient has irreversible liver-based disease which will be cured by getting a new liver. Thus, those with diseases which are primarily based outside the liver or have spread beyond the liver are generally considered poor candidates. Some examples include: Importantly, many contraindications to liver transplantation are considered reversible;

1133-584: A purine antagonist such as mycophenolate mofetil . Clinical outcome is better with tacrolimus than with ciclosporin during the first year of liver transplantation. If the patient has a co-morbidity such as active hepatitis B, high doses of hepatitis B immunoglubins are administered in liver transplant patients. Due to both the pharmacological immunosuppression and the immunosuppression of underlying liver disease, vaccinations against vaccination-preventable diseases are highly recommended before and after liver transplantation. Vaccine hesitancy in transplant recipients

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1236-524: A recipient, immediately after the recipient's diseased liver has been entirely removed. Historically, LDLT began with terminal pediatric patients, whose parents were motivated to risk donating a portion of their compatible healthy livers to replace their children's failing ones. The first report of successful LDLT was by Silvano Raia at the University of São Paulo Faculty of Medicine in July 1989. It

1339-515: A rising interest in normothermic regional perfusion (NRP), a technique that temporarily restores oxygenated blood flow to organs after death, thereby improving their viability prior to recovery. NRP works by reversing the detrimental effects of warm ischemia on cellular energy substrates and antioxidants, thereby reconditioning the organs before transplantation. This technique, often facilitated by extracorporeal membrane oxygenation (ECMO) technology, allows for organ assessment and optimization, reducing

1442-594: A risk factor. A fomite ( / ˈ f oʊ m aɪ t / ) or fomes ( / ˈ f oʊ m iː z / ) is any inanimate object that, when contaminated with or exposed to infectious agents (such as pathogenic bacteria , viruses or fungi ), can transfer disease to a new host . Personal-care items such as razors, toothbrushes, and manicuring or pedicuring equipment can be contaminated with blood. Sharing such items can potentially lead to exposure to HCV. Appropriate caution should be taken regarding any medical condition that results in bleeding , such as cuts and sores. HCV

1545-405: A single partner. There are a number of diagnostic tests for hepatitis C , including HCV antibody enzyme immunoassay (ELISA), recombinant immunoblot assay , and quantitative HCV RNA polymerase chain reaction (PCR). HCV RNA can be detected by PCR typically one to two weeks after infection, while antibodies can take substantially longer to form and thus be detected. Diagnosing patients

1648-620: A standard clinical treatment for both adult and pediatric patients with appropriate indications. Liver transplantation is now performed at over one hundred centers in the US, as well as numerous centres in Europe and elsewhere. The limited supply of liver allografts from non-living donors relative to the number of potential recipients spurred the development of living donor liver transplantation . The first altruistic living liver donation in Britain

1751-444: A useful medicine suggested by their doctors, or both. For example, in 2011, Cedars-Sinai Medical Center denied a liver transplant to medical cannabis patient Norman Smith. They removed Mr. Smith from a transplant waiting list for "non-compliance of our substance abuse contract", despite his own oncologist at Cedars-Sinai having recommended that he use the cannabis for his pain and chemotherapy. Dr. Steven D. Colquhoun, director of

1854-447: Is a 0.5 to 1.0 percent chance of death . Other risks of donating a liver include bleeding, infection, painful incision, possibility of blood clots and a prolonged recovery. The vast majority of donors enjoy complete and full recovery within 2–3 months. In children, living liver donor transplantation has become very accepted. The accessibility of adult parents who want to donate a piece of the liver for their children/infants has reduced

1957-536: Is a potential treatment for acute or chronic conditions which cause irreversible and severe ("end-stage") liver dysfunction. Since the procedure carries relatively high risks, is resource-intensive, and requires major life modifications after surgery, it is reserved for dire circumstances. Judging the appropriateness/effectiveness of liver transplant on case-by-case basis is critically important ( see Contraindications ), as outcomes are highly variable. The Model for End Stage Liver Disease ( MELD score ) for adults and

2060-784: Is also associated with autoimmune disorders such as Sjögren's syndrome , lichen planus , a low platelet count , porphyria cutanea tarda , necrolytic acral erythema , insulin resistance , diabetes mellitus , diabetic nephropathy , autoimmune thyroiditis , and B-cell lymphoproliferative disorders . 20–30% of people infected have rheumatoid factor – a type of antibody. Possible associations include Hyde's prurigo nodularis and membranoproliferative glomerulonephritis . Cardiomyopathy with associated abnormal heart rhythms has also been reported. A variety of central and peripheral nervous system disorders has been reported. Chronic infection seems to be associated with an increased risk of pancreatic cancer . People may experience other issues in

2163-488: Is also recommended for those with elevated liver enzymes, as this is frequently the only sign of chronic hepatitis. As of 2012 , the U.S. Centers for Disease Control and Prevention (CDC) recommends a single screening test for those born between 1945 and 1965. In Canada, a one-time screening is recommended for those born between 1945 and 1975. As of 2022, no approved vaccine protects against contracting hepatitis C . A combination of harm reduction strategies, such as

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2266-421: Is an important part of the selection process to differentiate transplant candidates who have alcohol use disorder as opposed to those who were susceptible to non-dependent alcohol use. The latter who gain control of alcohol use have a good prognosis following transplantation. Once a diagnosis of alcoholism has been established, however, it is necessary to assess the likelihood of future sobriety. Historically, HIV

2369-833: Is associated with decreased tissue re-perfusion ischemic injury (a process in which liver cells are damaged as a statically stored liver is re-perfused after transplant) as well as a decreased risk of intrahepatic biliary strictures. A 2014 study showed that the liver preservation time could be significantly extended using a supercooling technique, which preserves the liver at subzero temperatures (-6 °C) Donation after circulatory death (DCD) has become an increasingly important source of organs for transplantation, with categories ranging from uncontrolled to controlled DCD (cDCD) donors. Despite its growing use, DCD organs generally suffer from warm ischemia injuries, leading to fewer and lower-quality organs compared to those from donation after brain death (DBD). To mitigate these issues, there has been

2472-414: Is associated with two to threefold increased risk of hepatitis C . This could be due to either improperly sterilized equipment or contamination of the dyes being used. Tattoos or piercings performed either before the mid-1980s, "underground", or nonprofessionally are of particular concern, since sterile techniques in such settings may be lacking. The risk also appears to be greater for larger tattoos. It

2575-563: Is believed that ten million intravenous drug users are infected with hepatitis C ; China (1.6 million), the United States (1.5 million), and Russia (1.3 million) have the highest absolute totals. Occurrence of hepatitis C among prison inmates in the United States is 10 to 20 times that of the occurrence observed in the general population; this has been attributed to high-risk behavior in prisons such as IDU and tattooing with non-sterile equipment. Shared intranasal drug use may also be

2678-477: Is defined as the presence of detectable viral replication for at least six months. Though most experience minimal or no symptoms during the initial few decades of a chronic infection, chronic hepatitis C can be associated with fatigue and mild cognitive problems. After several years, chronic infection may cause cirrhosis or liver cancer . The liver enzymes measured from blood samples are normal in 7–53%. (Elevated levels indicate liver cells are being damaged by

2781-550: Is estimated that nearly half of prison inmates share unsterilized tattooing equipment. It is rare for tattoos in a licensed facility to be directly associated with HCV infection. Injection drug use (IDU) is a major risk factor for hepatitis C in many parts of the world. Of 77 countries reviewed, 25 (including the United States) were found to have a prevalence of hepatitis C of 60–80% among people who use injection drugs. Twelve countries had rates greater than 80%. It

2884-420: Is exceedingly rare. Symptoms and laboratory findings suggestive of liver disease should prompt further tests and can thus help establish a diagnosis of hepatitis C infection early on. Following the acute phase, the infection may resolve spontaneously in 10–50% of affected people; this occurs more frequently in young people and females. About 70% of those exposed to the virus develop a chronic infection. This

2987-449: Is generally a challenge as patients with acute illness generally present with mild, non-specific flu-like symptoms, while the transition from acute to chronic is sub-clinical. Chronic hepatitis C is defined as infection with the hepatitis C virus persisting for more than six months based on the presence of its RNA. Chronic infections are typically asymptomatic during the first few decades, and thus are most commonly discovered following

3090-505: Is generally considered safe at reduced doses. Nonsteroidal anti-inflammatory drugs (NSAIDs) are not recommended in those with advanced liver disease due to an increased risk of bleeding. Ultrasound surveillance for hepatocellular carcinoma is recommended in those with accompanying cirrhosis. Coffee consumption has been associated with a slower rate of liver scarring in those infected with HCV. More than 95% of chronic cases clear with treatment. Treatment with antiviral medication

3193-419: Is less than in the general population. Vaccinations are preferably administered to the recipient before the transplant, as post-transplant immunosuppression leads to reduced vaccine effectiveness. Liver transplantation is unique in that the risk of chronic rejection also decreases over time, although the great majority of recipients need to take immunosuppressive medication for the rest of their lives. It

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3296-540: Is more common in those also infected with hepatitis B , schistosoma , or HIV, in alcoholics , and in those of male sex. In those with hepatitis C, excess alcohol increases the risk of developing cirrhosis 5-fold. Those who develop cirrhosis have a 20-fold greater risk of hepatocellular carcinoma . This transformation occurs at a rate of 1–3% per year. Being infected with hepatitis B in addition to hepatitis C increases this risk further. Liver cirrhosis may lead to portal hypertension , ascites (accumulation of fluid in

3399-475: Is no vaccine against hepatitis C. Prevention includes harm reduction efforts among people who inject drugs, testing donated blood, and treatment of people with chronic infection. Chronic infection can be cured more than 95% of the time with antiviral medications such as sofosbuvir or simeprevir . Peginterferon and ribavirin were earlier generation treatments that proved successful in <50% of cases and caused greater side effects. While access to

3502-422: Is not clear when transmission occurs during pregnancy, but it may occur both during gestation and at delivery. A long labor is associated with a greater risk of transmission. There is no evidence that breastfeeding spreads HCV; however, to be cautious, an infected mother is advised to avoid breastfeeding if her nipples are cracked and bleeding, or if her viral loads are high. Sexual transmission of hepatitis C

3605-479: Is not spread through breast milk, food, water or casual contact such as hugging, kissing and sharing food or drinks with an infected person. It is one of five known hepatitis viruses: A , B , C, D , and E . Diagnosis is by blood testing to look for either antibodies to the virus or viral RNA . In the United States , screening for HCV infection is recommended in all adults age 18 to 79 years old. There

3708-413: Is not spread through casual contact, such as hugging, kissing, or sharing eating or cooking utensils, nor is it transmitted through food or water. Blood transfusion , transfusion of blood products, or organ transplants without HCV screening carry significant risks of infection. The United States instituted universal screening in 1992, and Canada instituted universal screening in 1990. This decreased

3811-459: Is placed in the same anatomic location. The transplant operation can be conceptualized as consisting of the hepatectomy (liver removal) phase, the anhepatic (no liver) phase, and the postimplantation phase. The operation is done through a large incision in the upper abdomen. The hepatectomy involves division of all ligamentous attachments to the liver, as well as the common bile duct, hepatic artery, all three hepatic veins and portal vein. Usually,

3914-418: Is positive, a confirmatory test is then performed to verify the immunoassay and to determine the viral load . A recombinant immunoblot assay is used to verify the immunoassay and the viral load is determined by an HCV RNA polymerase chain reaction. If there is no RNA and the immunoblot is positive, it means that the person tested had a previous infection but cleared it either with treatment or spontaneously; if

4017-420: Is possible to be slowly taken off anti rejection medication but only in certain cases. It is theorized that the liver may play a yet-unknown role in the maturation of certain cells pertaining to the immune system . There is at least one study by Thomas E. Starzl 's team at the University of Pittsburgh which consisted of bone marrow biopsies taken from such patients which demonstrate genotypic chimerism in

4120-648: Is probably due to preexisting disease of the donated organ. Others include technical flaws during surgery such as revascularization that may lead to a nonfunctioning graft. As with many experimental models used in early surgical research, the first attempts at liver transplantation were performed on dogs. The earliest published reports of canine liver transplantations were performed in 1954 by Vittorio Staudacher at Ospedale Maggiore Policlinico in Milan, Italy. This initial attempt varied significantly from contemporary techniques; for example, Staudacher reported "arterialization" of

4223-437: Is recommended for all people with proven chronic hepatitis C who are not at high risk of death from other causes. People with the highest complication risk, which is based on the degree of liver scarring, should be treated first. The initial recommended treatment depends on the type of hepatitis C virus, if the person has received previous hepatitis C treatment, and whether the person has cirrhosis. Direct-acting antivirals are

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4326-499: Is restored to the new liver, the biliary (bile duct) anastomosis is constructed, either to the recipient's own bile duct or to the small intestine. The surgery usually takes between five and six hours, but may be longer or shorter due to the difficulty of the operation and the experience of the surgeon. The large majority of liver transplants use the entire liver from a non-living donor for the transplant, particularly for adult recipients. A major advance in pediatric liver transplantation

4429-480: Is the time that the organ does not receive blood flow (after death/removal until graft placement). Biliary complications are routinely treated with Endoscopic Retrograde Cholangiopancreatography ( ERCP ), percutaneous drainage, or sometimes re-operation. Vascular complications include thrombosis , stenosis, pseudoaneurysm, and rupture of the hepatic artery. Venous complications occur less often compared with arterial complications, and include thrombosis or stenosis of

4532-614: Is uncommon. Studies examining the risk of HCV transmission between heterosexual partners, when one is infected and the other is not, have found very low risks. Sexual practices that involve higher levels of trauma to the anogenital mucosa, such as anal penetrative sex , or that occur when there is a concurrent sexually transmitted infection , including HIV or genital ulceration , present greater risks. The United States Department of Veterans Affairs recommends condom use to prevent hepatitis C transmission in those with multiple partners, but not those in relationships that involve only

4635-422: Is under investigation. The consequences of occult infection appear to be less severe than with chronic infection but can vary from minimal to hepatocellular carcinoma. The rate of occult infection in those apparently cured is controversial but appears to be low. 40% of those with hepatitis but with both negative hepatitis C serology and the absence of detectable viral genome in the serum have hepatitis C virus in

4738-651: The hepatitis C virus (HCV) that primarily affects the liver ; it is a type of viral hepatitis . During the initial infection period, people often have mild or no symptoms. Early symptoms can include fever, dark urine, abdominal pain, and yellow tinged skin . The virus persists in the liver, becoming chronic , in about 70% of those initially infected. Early on, chronic infection typically has no symptoms. Over many years however, it often leads to liver disease and occasionally cirrhosis . In some cases, those with cirrhosis will develop serious complications such as liver failure , liver cancer , or dilated blood vessels in

4841-541: The provision of new needles and syringes and treatment of substance use , decreases the risk of hepatitis C in people using injection drugs by about 75%. The screening of blood donors is important at a national level, as is adhering to universal precautions within healthcare facilities. In countries where there is an insufficient supply of sterile syringes , medications should be given orally rather than via injection (when possible). Recent research also suggests that treating people with active infection, thereby reducing

4944-482: The Liver Transplant Program, said that the hospital "must consider issues of substance abuse seriously", but the transplant center did not seriously consider whether Mr. Smith was "using" cannabis versus "abusing" it. In 2012, Cedars-Sinai denied a liver transplant to a second patient, Toni Trujillo, after her Cedars-Sinai doctors knew and approved of her legal use of medical cannabis. In both cases,

5047-494: The Pediatric End Stage Liver Disease (PELD score) for children younger than 12 years old are clinical scoring tools that take various clinical criteria into consideration and are used to assess the need for a liver transplant. Higher scores for each clinical scoring tool indicates a higher severity of liver disease, and thus a greater need for a liver transplant. In those with chronic liver disease,

5150-551: The United States and Canada are aware of their status. Routine screening for those between the ages of 18 and 79 was recommended by the United States Preventive Services Task Force in 2020. Previously, testing was recommended for those at high risk, including injection drug users, those who have received blood transfusions before 1992, those who have been incarcerated, those on long-term hemodialysis , and those with tattoos. Screening

5253-513: The United States is low. The LDLT donor's immune system does diminish as a result of the liver regenerating, so certain foods which would normally cause an upset stomach could cause serious illness. Any member of the family, parent, sibling, child, spouse or a volunteer can donate their liver. The criteria for a liver donation include: Living donor surgery is done at a major center. Very few individuals require any blood transfusions during or after surgery. All potential donors should know there

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5356-513: The University of Zurich. A randomized controlled clinical trial comparing normothermic machine preservation with conventional cold storage showed less donor liver injury, less discarded donor livers (due to suboptimal condition), better early function, and longer preservation times compared with static cold stored livers. Graft survival and patient survival after transplant were similar with both approaches. Machine perfusion prior to transplant

5459-489: The abdomen), easy bruising or bleeding , varices (enlarged veins, especially in the stomach and esophagus), jaundice , and a syndrome of cognitive impairment known as hepatic encephalopathy . Ascites occurs at some stage in more than half of those who have a chronic infection. The most common problem due to hepatitis C but not involving the liver is mixed cryoglobulinemia (usually the type II form) – an inflammation of small and medium-sized blood vessels . Hepatitis C

5562-437: The appropriate size in the recipient as well, although it will take longer than for the donor. Living donors are faced with risks and/or complications after the surgery. Blood clots and biliary problems have the possibility of arising in the donor post-op, but these issues are remedied fairly easily. Although death is a risk that a living donor must be willing to accept prior to the surgery, the mortality rate of living donors in

5665-537: The bone marrow of liver transplant recipients. The prognosis following liver transplant is variable, depending on overall health, technical success of the surgery, and the underlying disease process affecting the liver. There is no exact model to predict survival rates; those with transplant have a 58% chance of surviving 15 years. Failure of the new liver ( primary nonfunction in liver transplantation or PNF ) occurs in 10% to 15% of all cases. These percentages are contributed to by many complications. Early graft failure

5768-408: The degree of liver damage present; however, there are risks from the procedure. The typical changes seen are lymphocytes within the parenchyma, lymphoid follicles in portal triad , and changes to the bile ducts. There are a number of blood tests available that try to determine the degree of hepatic fibrosis and alleviate the need for biopsy. It is believed that only 5–50% of those infected in

5871-432: The donor portal vein via the recipient hepatic artery, and use of cholecystostomy for biliary drainage. The first attempted human liver transplant was performed in 1963 by Thomas Starzl , although the pediatric patient died intraoperatively due to uncontrolled bleeding. Multiple subsequent attempts by various surgeons remained unsuccessful until 1967, when Starzl transplanted a 19-month-old girl with hepatoblastoma who

5974-457: The esophagus and stomach . HCV is spread primarily by blood-to-blood contact associated with injection drug use , poorly sterilized medical equipment, needlestick injuries in healthcare, and transfusions . In regions where blood screening has been implemented, the risk of contracting HCV from a transfusion has dropped substantially to less than one per two million. HCV may also be spread from an infected mother to her baby during birth. It

6077-403: The ethical problems underlying the indication of a major surgical operation ( hemihepatectomy or related procedure) on a healthy human being. In various case series, the risk of complications in the donor is around 10%, and very occasionally a second operation is needed. Common problems are biliary fistula , gastric stasis and infections ; they are more common after removal of the right lobe of

6180-406: The first six months of infection (the acute stage) is more effective than when hepatitis C has entered the chronic stage. In those with chronic hepatitis B, treatment for hepatitis C results in reactivation of hepatitis B about 25% of the time. Cirrhosis due to hepatitis C is a common reason for liver transplantation , though the virus usually (80–90% of cases) recurs afterwards. Infection of

6283-421: The following: long-term alcohol use disorder , long-term untreated hepatitis C infection, long-term untreated hepatitis B infection. The concept of LDLT is based on (1) the remarkable regenerative capacities of the human liver and (2) the widespread shortage of cadaveric livers for patients awaiting transplant . In LDLT, a piece of healthy liver is surgically removed from a living person and transplanted into

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6386-482: The genotype. In the United States, about 70% of cases are caused by genotype 1, 20% by genotype 2 and about 1% by each of the other genotypes. Genotype 1 is also the most common in South America and Europe. The half life of the virus particles in the serum is around 3 hours and may be as short as 45 minutes. In an infected person, about 10 virus particles are produced each day. In addition to replicating in

6489-625: The graft leads to 10–30% of people developing cirrhosis within five years. Treatment with pegylated interferon and ribavirin post-transplant decreases the risk of recurrence to 70%. A 2013 review found no clear evidence as to whether antiviral medication is useful if the graft became reinfected. Several alternative therapies are claimed by their proponents to be helpful for hepatitis C , including milk thistle , ginseng , and colloidal silver . However, no alternative therapy has been shown to improve outcomes for hepatitis C patients, and no evidence exists that alternative therapies have any effect on

6592-519: The immunoblot is negative, it means that the immunoassay was wrong. It takes about 6–8 weeks following infection before the immunoassay will test positive. A number of tests are available as point-of-care testing (POCT), which can provide results within 30 minutes. Liver enzymes are variable during the initial part of the infection and on average begin to rise at seven weeks after infection. The elevation of liver enzymes does not closely follow disease severity. Liver biopsies are used to determine

6695-661: The implementation and enforcement of stringent standard precautions in public and private medical and dental facilities are known to have been the primary cause of the spread of HCV in Egypt , the country that had the highest rate of infection in the world in 2012, and currently Egypt becomes the first country to achieve WHO validation on the path to elimination of hepatitis C. For more, see HONOReform (Hepatitis Outbreaks National Organization for Reform) . Mother-to-child transmission of hepatitis C occurs in fewer than 10% of pregnancies. There are no measures that alter this risk. It

6798-478: The importance of monitoring iciHHV-6 reactivation in liver transplant recipients. The high incidence of liver transplants given to those with alcoholic cirrhosis has led to a recurring controversy regarding the eligibility of such patients for liver transplant. The controversy stems from the view of alcoholism as a self-inflicted disease and the perception that those with alcohol-induced damage are depriving other patients who could be considered more deserving. It

6901-475: The investigation of elevated liver enzyme levels or during a routine screening of high-risk individuals. Testing is not able to distinguish between acute and chronic infections. Diagnosis in infants is difficult as maternal antibodies may persist for up to 18 months. Hepatitis C testing typically begins with blood testing to detect the presence of antibodies to the HCV, using an enzyme immunoassay. If this test

7004-407: The link to point directly to the intended article. Retrieved from " https://en.wikipedia.org/w/index.php?title=HEPC&oldid=861465317 " Category : Disambiguation pages Hidden categories: Short description is different from Wikidata All article disambiguation pages All disambiguation pages Hepatitis C Hepatitis C is an infectious disease caused by

7107-467: The liver ( Couinaud segments 2 and 3). Further advance in liver transplant involves only resection of the lobe of the liver involved in tumors and the tumor-free lobe remains within the recipient. This speeds up the recovery and the patient stay in the hospital quickly shortens to within 5–7 days. Radiofrequency ablation of the liver tumor can be used as a bridge while awaiting liver transplantation. Between removal from donor and transplantation into

7210-410: The liver (the right lobe) is removed from a healthy living donor. The donor's liver will regenerate approaching 100% function within 4–6 weeks, and will almost reach full volumetric size with recapitulation of the normal structure soon thereafter. It may be possible to remove up to 70% of the liver from a healthy living donor without harm in most cases. The transplanted portion will reach full function and

7313-422: The liver on biopsy. How commonly this occurs in children is unknown. The hepatitis C virus (HCV) is a small, enveloped, single-stranded, positive-sense RNA virus . It is a member of the genus Hepacivirus in the family Flaviviridae . There are seven major genotypes of HCV, which are known as genotypes one to seven. The genotypes are divided into several subtypes with the number of subtypes depending on

7416-591: The liver the virus can multiply in lymphocytes. Percutaneous contact with contaminated blood is responsible for most infections; however, the method of transmission is strongly dependent on both geographic region and economic status. Indeed, the primary route of transmission in the developed world is injection drug use , while in the developing world the main methods are blood transfusions and unsafe medical procedures. The cause of transmission remains unknown in 20% of cases; however, many of these are believed to be accounted for by injection drug use. Tattooing

7519-523: The liver. Death after LDLT has been reported at 0% (Japan), 0.3% (USA) and <1% (Europe), with risks likely to decrease further as surgeons gain more experience in this procedure. Since the law was changed to permit altruistic non-directed living organ donations in the UK in 2006, the first altruistic living liver donation took place in Britain in December 2012. In a typical adult recipient LDLT, 55 to 70% of

7622-438: The mouth such as dryness , salivary duct stones , and crusted lesions around the mouth. Persons who have been infected with hepatitis C may appear to clear the virus but remain infected. The virus is not detectable with conventional testing but can be found with ultra-sensitive tests. The original method of detection was by demonstrating the viral genome within liver biopsies, but newer methods include an antibody test for

7725-931: The multi-disciplinary transplant team on an individual basis. After a liver transplantation, immune-mediated rejection (also known as rejection ) of the allograft may happen at any time. Rejection may present with lab findings: elevated AST, ALT, GGT; abnormal liver function values such as prothrombin time, ammonia level, bilirubin level, albumin concentration; and abnormal blood glucose. Physical findings may include encephalopathy, jaundice, bruising and bleeding tendency. Other nonspecific presentation may include malaise, anorexia, muscle ache, low fever, slight increase in white blood count and graft-site tenderness. Three types of graft rejection may occur: hyperacute rejection, acute rejection, and chronic rejection. Biliary complications include biliary stenosis, biliary leak, and ischemic cholangiopathy. The risk of ischemic cholangiopathy increases with longer durations of cold ischemia time, which

7828-532: The newer treatments was expensive, by 2022 prices had dropped dramatically in many countries (primarily low-income and lower-middle-income countries) due to the introduction of generic versions of medicines. Those who develop cirrhosis or liver cancer may require a liver transplant . Hepatitis C is one of the leading reasons for liver transplantation, though the virus usually recurs after transplantation. An estimated 58 million people worldwide were infected with hepatitis C in 2019. Approximately 290,000 deaths from

7931-575: The number of children who would have otherwise died waiting for a transplant. Having a parent as a donor also has made it a lot easier for children – because both patients are in the same hospital and can help boost each other's morale. There are several advantages of living liver donor transplantation over cadaveric donor transplantation, including: Living donor transplantation is a multidisciplinary approach. All living liver donors undergo medical evaluation. Every hospital which performs transplants has dedicated nurses that provide specific information about

8034-543: The patients acceded to the hospital's demand and stopped using cannabis, despite its therapeutic benefits for them, but were both sent back to the bottom of the transplant list. Smith's death inspired Americans for Safe Access to lobby for the California Medical Cannabis Organ Transplant Act (AB 258), which was enacted in July 2015 to protect future patients from dying at the hands of medical establishments prejudiced against

8137-409: The portal vein, hepatic vein, or vena cava. Before transplantation, liver-support therapy might be indicated (bridging-to-transplantation). Artificial liver support like liver dialysis or bioartificial liver support concepts are currently under preclinical and clinical evaluation. Virtually all liver transplants are done in an orthotopic fashion; that is, the native liver is removed and the new liver

8240-413: The potential for transmission, may be an effective preventive measure. Hepatitis C vaccine phase 1 clinical trials are set to begin in the summer of 2023. Those with chronic hepatitis C are advised to avoid alcohol and medications that are toxic to the liver . They should also be vaccinated against hepatitis A and hepatitis B due to the increased risk if also infected. Use of acetaminophen

8343-492: The preferred treatment and have been validated by testing for virus particles in patients' blood. More than 95% of people with chronic infection can be cured when treated with medications; this could be expensive, but by 2022 prices had dropped dramatically. The combination of sofosbuvir, velpatasvir, and voxilaprevir may be used in those who have previously been treated with sofosbuvir or other drugs that inhibit NS5A and were not cured. Prior to 2011, treatments consisted of

8446-443: The procedure and answer questions that families may have. During the evaluation process, confidentiality is assured on the potential donor. Every effort is made to ensure that organ donation is not made by coercion from other family members. The transplant team provides both the donor and family thorough counseling and support which continues until full recovery is made. All donors are assessed medically to ensure that they can undergo

8549-451: The recipient, the allograft liver is stored in a temperature-cooled preservation solution. The reduced temperature slows down the process of deterioration from normal metabolic processes, and the storage solution itself is designed to counteract the unwanted effects of cold ischemia. Although "static" cold storage method has long been standard technique, various dynamic preservation methods are under investigation. For example, systems which use

8652-468: The retrohepatic portion of the inferior vena cava is removed along with the liver, although an alternative technique preserves the recipient's vena cava ("piggyback" technique). The donor's blood in the liver will be replaced by an ice-cold organ storage solution, such as UW ( Viaspan ) or HTK , until the allograft liver is implanted. Implantation involves anastomoses (connections) of the inferior vena cava, portal vein, and hepatic artery. After blood flow

8755-417: The risk from one in 200 units to between one in 10,000 to one in 10,000,000 per unit of blood. This low risk remains as there is a period of about 11–70 days between the potential blood donor 's acquiring hepatitis C and the blood's testing positive depending on the method. Some countries do not screen for hepatitis C due to the cost. Those who have experienced a needle stick injury from someone who

8858-507: The risk of cirrhosis after 20 years varies between studies but has been estimated at ~10–15% for men and ~1–5% for women. The reason for this difference is not known. Once cirrhosis is established, the rate of developing hepatocellular carcinoma is ~1–4% per year. Rates of new infections have decreased in the Western world since the 1990s due to improved screening of blood before transfusion. Liver transplant Liver transplantation

8961-533: The risk of graft failure. NRP can be established either abdominally or thoracoabdominally, depending on the intended organs for transplantation, with specific techniques and monitoring protocols in place to ensure optimal outcomes. Clinical outcomes of NRP in DCD organ transplantation have shown promising results, particularly in kidney and liver transplantation, with lower rates of complications and improved graft survival compared to traditional preservation methods. Through

9064-429: The surgery. Blood type of the donor and recipient must be compatible but not always identical. Other things assessed prior to surgery include the anatomy of the donor liver. However, even with mild variations in blood vessels and bile duct , surgeons today are able to perform transplantation without problems. The most important criterion for a living liver donor is to be in excellent health. Like most other allografts,

9167-519: The use of NRP in controlled DCD scenarios, ongoing research aims to address these concerns and expand the application of NRP to other organ types, ultimately increasing the availability of viable organs for transplantation and improving outcomes for patients with end-stage organ disease A study published in The Journal of Infectious Diseases in 2024 investigated the reactivation of inherited chromosomally integrated human herpesvirus 6 (iciHHV-6B) in

9270-461: The utilization of NRP, Dr. Fondevila et al. at Hospital Universitario La Paz have achieved successful transplantation of livers that have undergone extensive warm ischemic periods of up to 2.5 hours prior to recovery. This has resulted in biliary complication and graft survival rates comparable to those observed in controlled DCD livers that have experienced significantly less warm ischemia. While ethical considerations remain, especially regarding

9373-519: The virus or other disease). Late relapses after apparent cure have been reported, but these can be difficult to distinguish from reinfection. Fatty changes to the liver occur in about half of those infected and are usually present before cirrhosis develops. Usually (80% of the time) this change affects less than a third of the liver. Worldwide hepatitis C is the cause of 27% of cirrhosis cases and 25% of hepatocellular carcinoma. About 10–30% of those infected develop cirrhosis over 30 years. Cirrhosis

9476-412: The virus within six months, before the infection is considered chronic. Spontaneous resolution following acute infection appears more common in females and in patients who are younger, and may be influenced by certain genetic factors. Chronic HCV infection may also resolve spontaneously months or years after the acute phase has passed, though this is unusual. The World Health Organization estimated in

9579-818: The virus' core protein and the detection of the viral genome after first concentrating the viral particles by ultracentrifugation . A form of infection with persistently moderately elevated serum liver enzymes but without antibodies to hepatitis C has also been reported. This form is known as cryptogenic occult infection. Several clinical pictures have been associated with this type of infection. It may be found in people with anti-hepatitis-C antibodies but with normal serum levels of liver enzymes; in antibody-negative people with ongoing elevated liver enzymes of unknown cause; in healthy populations without evidence of liver disease; and in groups at risk for HCV infection including those on hemodialysis or family members of people with occult HCV. The clinical relevance of this form of infection

9682-811: The virus, mainly from liver cancer and cirrhosis attributed to hepatitis C, also occurred in 2019. The existence of hepatitis C – originally identifiable only as a type of non- A non- B hepatitis – was suggested in the 1970s and proven in 1989. Hepatitis C infects only humans and chimpanzees . Acute symptoms develop in some 20% of those infected. When this occurs, it is generally 4–12 weeks following infection (but it may take from 2 weeks to 6 months for acute symptoms to appear). Symptoms are generally mild and vague, and may include fatigue, nausea and vomiting, fever, muscle or joint pains , abdominal pain, decreased appetite and weight loss, jaundice (occurs in ~25% of those infected), dark urine, and clay-coloured stools. Acute liver failure due to acute hepatitis C

9785-577: The virus. The responses to treatment is measured by sustained viral response (SVR), defined as the absence of detectable RNA of the hepatitis C virus in blood serum for at least 24 weeks after discontinuing treatment, and rapid virological response (RVR), defined as undetectable levels achieved within four weeks of treatment. Successful treatment decreases the future risk of hepatocellular carcinoma by 75%. Prior to 2012, sustained response occurred in about 40–50% of those with HCV genotype 1 who received 48 weeks of treatment. A sustained response

9888-995: The virus. As a result, the number of chronic patients receiving treatment worldwide has grown from about 950,000 in 2015 to 9.4 million in 2019. During the same period, hepatitis C deaths declined from about 400,000 to 290,000. Previously, a 2013 study found high infection rates (>3.5% population infected) in Central and East Asia, North Africa and the Middle East, intermediate infection rates (1.5–3.5%) in South and Southeast Asia, sub-Saharan Africa, Andean, Central and Southern Latin America, Caribbean, Oceania, Australasia and Central, Eastern and Western Europe; and low infection rates (<1.5%) in Asia-Pacific, Tropical Latin America and North America. Among those chronically infected,

9991-572: Was HCV positive have about a 1.8% chance of subsequently contracting the disease themselves. The risk is greater if the needle in question is hollow and the puncture wound is deep. There is a risk from mucosal exposures to blood, but this risk is low, and there is no risk if blood exposure occurs on intact skin. Hospital equipment has also been documented as a method of transmission of hepatitis C , including reuse of needles and syringes, multiple-use medication vials, infusion bags, and improperly sterilized surgical equipment, among others. Limitations in

10094-427: Was able to survive for over one year before dying of metastatic disease. Despite the development of viable surgical techniques, liver transplantation remained experimental through the 1970s, with one year patient survival in the vicinity of 25%. The introduction of ciclosporin by Sir Roy Calne , Professor of Surgery Cambridge, markedly improved patient outcomes, and the 1980s saw recognition of liver transplantation as

10197-769: Was considered an absolute contraindication to liver transplantation. This was in part due to concern that the infection would be worsened by the immunosuppressive medication which is required after transplantation. However, with the advent of highly active antiretroviral therapy (HAART), people with HIV have much improved prognosis. HIV controlled with HAART is no longer a contraindication to liver transplantation. Uncontrolled HIV disease (AIDS) remains an absolute contraindication. Medical criteria for transplant often require "lack of substance abuse". The changing status of cannabis has resulted in many patients who never abused any substance – merely used one – either being turned down for transplants, forced to stop

10300-491: Was followed by Christoph Broelsch at the University of Chicago Medical Center in November 1989, when two-year-old Alyssa Smith received a portion of her mother's liver. Surgeons eventually realized that adult-to-adult LDLT was also possible, and now the practice is common in a few reputable medical institutes. It is considered more technically demanding than even standard, cadaveric donor liver transplantation, and also poses

10403-518: Was performed in December 2012 in St James University Hospital Leeds. See also: Category:Liver transplant recipients and List of organ transplant donors and recipients There is increasing interest in improving methods for allograft preservation following organ harvesting. The standard "static cold storage" technique relies on flushing a liver with a preservation solution and then placing it in static cold storage at

10506-566: Was seen in 70–80% of people with HCV genotypes 2 and 3 following 24 weeks of treatment. A sustained response occurs for about 65% of those with genotype 4 after 48 weeks of treatment. For those with HCV genotype 6, a 48-week treatment protocol of pegylated interferon and ribavirin results in a higher rate of sustained responses than for genotype 1 (86% vs. 52%). Further studies are needed to determine results for shorter 24-week treatments and for those given at lower dosages. Around 30% (15–45%) of those with acute HCV infections will spontaneously clear

10609-495: Was the development of reduced size liver transplantation, in which a portion of an adult liver is used for an infant or small child. Further developments in this area included split liver transplantation, in which one liver is used for transplants for two recipients, and living donor liver transplantation, in which a portion of a healthy person's liver is removed and used as the allograft. Living donor liver transplantation for pediatric recipients involves removal of approximately 20% of

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