Prevention of hepatitis C recurrence after liver transplantation: An update

Abstract

Hepatitis C related liver failure and hepatocarcinoma are the most common indications for liver transplantation in Western countries. Recurrent hepatitis C infection of the allograft is universal and immediate following liver transplantation, being associated with accelerated progression to cirrhosis, graft loss and death. Graft and patient survival is reduced in liver transplant recipients with recurrent Hepatitis C virus (HCV) infection compared to HCV-negative recipients. Many variables may impact on recurrent HCV liver disease. Overall, excess immunosuppression is believed to be a key factor; however, no immunosuppressive regimen has been identified to be more beneficial or less harmful. Donor age limitations, exclusion of moderately to severely steatotic livers and minimization of ischemic times could be a potential strategy to minimize the severity of HCV disease in transplanted subjects. After transplantation, antiviral therapy based on pegylated IFN alpha with or without ribavirin is associated with far less results than that reported for immunocompetent HCV-infected patients. New findings in the field of immunotherapy and genomic medicine applied to this context are promising.

Efficacy and safety of direct-acting antiviral therapy in previous hard-to-treat patients with recurrent hepatitis C virus infection after liver transplantation: a real-world cohort

“… 1 Approximately 25% of primary HCC and 25% of liver cirrhosis are caused by chronic hepatitis C. 2 Thus, HCV-related liver failure and HCC have been the most frequent indications for liver transplantation (LT) in Western countries in the past two decades. 3 HCV infection itself cannot be cured by LT, and graft reinfection universally occurs. 4 , 5 Fibrosis progression after LT is accelerated under immunosuppressive therapy with high rates of HCV-associated recurrent cirrhosis.…”

Hepatitis C pathogenesis and outcomes after liver transplantation: Probing microRNA expression for new insights

“…Combination therapy with interferon‐α (IFN‐α) and ribavirin after liver transplantation is associated with response rates of generally less than 30% and entails the risk of inducing allograft rejection. In addition, toxicity‐related dropout rates are high . In the longer term the development of IFN‐free direct antiviral agent regimens may lead to significant improvements in our ability to treat this patient group.…”

“…In addition, toxicity-related dropout rates are high. 7 In the longer term the development of IFN-free direct antiviral agent regimens may lead to significant improvements in our ability to treat this patient group. However, the availability of protease inhibitor therapy as an adjunct to IFN-based treatment presents not inconsiderable challenges, as evidenced by recent data indicating substantial morbidity in the treatment of individuals with decompensated liver disease before transplantation, and also because of issues of significant drug interactions with calcineurin inhibitors after transplantation.…”