**4. Retransplant**

For those patients with recurrence of HCV who have a decompensated cirrhosis, a liver retransplant is the only curative option.The International Liver Transplantation Society Expert Panel indicates that recipients aged >55 years, donors >40 years, a bilirubin ≥10 mg/dl, creatinine clearance <40 ml/min and early recurrence of HCV-related cirrhosis after transplant are all associated with a worse prognosis after retransplant (Carrion et al, 2010b). The development of fibrosing cholestatic hepatitis also has an unfavourable prognosis after retransplant (Marti et al, 2008).

Models predicting survival after retransplantation have been validated. These include the Markmann score (Markmann et al, 1999) and the Rosen score (Rosen et al, 1999), which appear to be the most accepted and enable prediction of the prognosis in the retransplant patient, thus improving associated survival. Generally speaking, it is recommended that a retransplant should be offered to those patients who have a likelihood of 1-year survival of at least 55%, which includes patients with a Rosen score <20.5 (Marti et al, 2008).

The cornerstone depends on reducing the number of candidates for retransplantation, identifying those patients who have accelerated recurrence and undertaking energetic measures for their management, as well as starting antiviral therapy.
