Antiviral Treatment for Hepatitis C Virus Infection after Liver Transplantation

Abstract

A significant proportion of patients with chronic hepatitis C virus (HCV) infection develop liver cirrhosis and complications of end-stage liver disease over two to three decades and require liver transplantation, however, reinfection is common and leads to further adverse events under immunosuppression. Pretransplant antiviral or preemptive therapy is limited to mildly decompensated patients due to poor tolerance. The mainstay of management represents directed antiviral therapy after evidence of recurrence of chronic hepatitis C. Combined pegylated interferon and ribavirin therapy is the current standard treatment with sustained viral response rates of 25% to 45%. The rate is lower than that in the immunocompetent population, partly due to the high prevalence of intolerability. To date, there is no general consensus regarding the antiviral treatment modality, timing, or dosing for HCV in patients with advanced liver disease and after liver transplantation. New anti-HCV drugs to delay disease progression or to enhance viral clearance are necessary.

Living Donor Liver Transplantation for Hepatocellular Carcinoma: The Japanese Experience

“…Another issue regarding liver transplantation for HCC unique to Japan compared to other countries in the region is that HCV remains the most common indication [42]. As a result, various antiviral treatments have been reported, modifying the approach taken in the West [43,44].…”

Determinant Factors of the Direct Medical Costs Associated with Genotype 1 Hepatitis C Infection in Treatment-Experienced Patients

“…Consequently, it is important to monitor liver disease severity and BLVL together and not independently as these parameters can reduce total MRU-related costs significantly when patients with CHC are treated early. Such an outcome has substantial implications when evaluating, for example, treatment strategies against HCV before and after liver transplantation in patients with advanced liver fibrosis [ 40 ]. It has been reported that spontaneous clearance of HCV after transplantation is rare while reinfection of the allograft is common; therefore reducing the prognosis of these patients [ 41 – 44 ].…”

Outcomes of treatment with daclatasvir and asunaprevir for recurrent hepatitis C after liver transplantation

“…The SVR rate achieved using the Peg‐IFN/RBV‐based regimen in a treatment‐naïve cohort increases to 68–89% when combined with the protease inhibitor telaprevir, boceprevir, or simeprevir (SMV) . Antiviral therapy using a Peg‐IFN/RBV‐based regimen in LT recipients, however, is more difficult due to drug–drug interactions and a high prevalence of intolerability with frequent adverse events …”

“…[6][7][8] Antiviral therapy using a Peg-IFN/RBV-based regimen in LT recipients, however, is more difficult due to drug-drug interactions and a high prevalence of intolerability with frequent adverse events. [9][10][11] Several therapies with IFN-free oral direct-acting antiviral (DAA) drugs were recently developed, leading to a high SVR rate with a shorter therapy duration and a lower rate of adverse events. 12 Combined therapy with the non-structural protein (NS)5A replication complex inhibitor daclatasvir (DCV) and the selective NS3 protease inhibitor asunaprevir (ASV) has shown robust antiviral activity and a high SVR rate, with no clinically significant pharmacokinetic interactions.…”