Abstract
Decompensated cirrhosis from hepatitis C virus (HCV) genotype 1 is the leading indication for liver transplantation in the United States, accounting for nearly 50% of all liver transplants. Recurrent HCV is universal after liver transplantation in patients viremic at the time of transplantation and leads to cirrhosis in up to 30% of patients by five years. Once cirrhosis develops, the risk of hepatic decompensation is 42% per year. This has led to recurrent HCV emerging as an important yet controversial indication for liver retransplantation and a renewed interest in the role of anti-viral therapies. Since the first report of interferon for recurrent HCV treatment in 1996, there have been several reports in the literature of interferon-based therapies for this silent epidemic. However, these studies are limited by a paucity of randomized controlled trials. Despite encouraging results with pegylated interferon and ribavirin in the non-transplant HCV population, these findings have not translated to transplant recipients where viral eradication is frequently unsuccessful (