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Management of posttransplant hepatitis C infection

Ayse Aytaman1, Marina Kaufman, Norah A Terrault

  • 1VA New York Harbor HCS Brooklyn, Brooklyn, New York 11209, USA. Ayse.Aytaman@va.gov

Current Opinion in Organ Transplantation
|May 7, 2010
PubMed

Insights

Optimizing hepatitis C virus (HCV) management before and after liver transplantation is crucial. Newer antiviral therapies (AVTs) promise better outcomes by preventing graft reinfection and improving patient survival.

Area of Science:

  • Hepatology
  • Transplantation Immunology
  • Virology

Background:

  • Chronic hepatitis C virus (HCV) infection is a primary indication for liver transplantation, but outcomes are often poorer due to universal graft reinfection.
  • Current antiviral therapies (AVTs) for HCV are frequently ineffective and poorly tolerated, limiting their utility in transplant settings.
  • Achieving a sustained virologic response (SVR) is linked to improved graft and patient survival post-transplantation.

Purpose of the Study:

  • To review recent advancements in the peritransplant management of HCV in liver transplant recipients.
  • To emphasize predictors of outcome, diagnosis, prevention, and control of HCV reinfection.
  • To discuss the potential impact of emerging specifically targeted AVTs for HCV (STAT-C) agents.

Main Methods:

  • Focus on recent data and clinical strategies for managing HCV in the peri-transplant period.
  • Analysis of factors influencing allograft outcomes and HCV recurrence.
  • Evaluation of current and future antiviral treatment paradigms.

Main Results:

  • Antiviral therapy (AVT) in select pre-transplant patients can eradicate HCV.
  • Optimizing immunosuppression (IMS) protocols, including steroid and calcineurin inhibitor (CNI) minimization, is key.
  • Careful donor selection, avoiding T-cell-depleting agents, and managing metabolic syndrome improve allograft outcomes and AVT response.

Conclusions:

  • Modified IMS protocols, judicious donor selection, and timely AVT before significant allograft damage can enhance outcomes for post-transplant HCV.
  • Emerging STAT-C agents are expected to significantly improve the efficacy of AVT in this patient population.
  • While current data on new agents are limited, they hold substantial promise for the future management of HCV in liver transplant recipients.
Abstract

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