Related Experiment Videos
Management of hepatitis C in liver transplant recipients
1Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA.
Insights
Recurrent hepatitis C virus (HCV) infection post-liver transplant leads to graft loss. Current interferon-based therapies show limited efficacy and tolerability, necessitating novel treatment strategies.
Area of Science:
- Hepatology
- Transplant Immunology
- Virology
Background:
- Recurrent hepatitis C virus (HCV) infection is a primary cause of graft loss in liver transplant recipients.
- The natural history of recurrent HCV disease is variable, with median time to cirrhosis under a decade.
- Factors influencing recurrence risk and fibrosis progression, such as donor age and viral load, are not fully understood.
Purpose of the Study:
- To review the current understanding of recurrent HCV disease in liver transplant recipients.
- To evaluate the efficacy and limitations of existing therapies, primarily interferon and ribavirin (RBV).
- To explore emerging and alternative treatment strategies for managing recurrent HCV post-transplantation.
Main Methods:
- Literature review of studies on recurrent HCV disease after liver transplantation.
- Analysis of factors associated with disease recurrence and progression.
- Assessment of current and investigational therapeutic approaches.
Main Results:
- Older donor age, acute rejection treatment, cytomegalovirus infection, and high pre-transplant viral load are linked to worse outcomes.
- Interferon and RBV therapy has lower efficacy and tolerability issues in transplant patients compared to non-transplant patients.
- Sustained responders often show stable or improved fibrosis, but optimal treatment parameters remain undetermined.
Conclusions:
- Interferon-based therapies have limited efficacy in liver transplant recipients with recurrent HCV.
- There is an urgent need for new, more effective drug therapies for post-transplant HCV.
- Alternative strategies, including pre-transplant and preemptive treatments, are under investigation.
Abstract:
Recurrent hepatitis C virus (HCV) disease is the leading cause of graft loss in liver transplant recipients with pre-transplant HCV infection. While natural history is variable, median time to recurrent cirrhosis is less than a decade. Factors contributing to risk of recurrence and rate of fibrosis progression are only partially known. Older donor age, treatment of acute rejection, cytomegalovirus infection and high pre-transplant viral load are most consistently linked with worse outcomes. Whether these factors can be modified to positively impact on HCV disease progression is unknown. The main therapeutic approach for patients with recurrent HCV disease has been the treatment with interferon and ribavirin (RBV) once recurrent disease is documented or progressive. Efficacy is lower than in nontransplant patients and tolerability, especially of RBV, is a major limitation. Stable or improved fibrosis scores are seen in the majority of sustained responders. Optimal dose, duration and timing of treatment have not been determined. Alternative strategies under study include pre-transplant treatment of decompensated cirrhotics, preemptive antiviral therapy started within weeks of transplantation and prophylactic therapy using HCV antibodies. Ongoing studies may establish a future role for alternative treatment approaches. Additionally, limited overall efficacy of interferon-based therapy in the transplant setting highlights the urgent need for new drug therapies.
Related Concept Videos
01:25Hepatitis
01:16Kidney Transplant III: Nursing Management
01:26Kidney Transplant II: Surgical Procedure
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
01:28Viral Hepatitis I: Introduction
01:28Kidney Transplant I: Introduction