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Treatment of chronic hepatitis C virus infection after liver transplantation

Kosh Agarwal1, Ashley Barnabas

  • 1Institute of Liver Studies, King's College Hospital, London, UK.

Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
|October 5, 2013
PubMed

Insights

Hepatitis C virus (HCV) recurrence post-liver transplant is common and reduces survival. New direct-acting antivirals offer improved treatment options for HCV genotype 1 patients, potentially enhancing graft and patient outcomes.

Area of Science:

  • Hepatology and Transplant Surgery
  • Virology and Infectious Diseases
  • Pharmacology and Therapeutics

Background:

  • Chronic hepatitis C virus (HCV) infection is a primary driver of end-stage liver disease and a leading indication for liver transplantation.
  • HCV recurrence post-transplantation is nearly universal, significantly diminishing graft and patient survival rates.
  • Current antiviral therapies, including pegylated interferon and ribavirin, demonstrate suboptimal efficacy (around 30% sustained virologic response) and carry significant side effects.

Purpose of the Study:

  • To review current antiviral treatment strategies for hepatitis C virus in liver transplant recipients.
  • To explore the potential of new directly acting antivirals (DAAs) for managing HCV recurrence, particularly in genotype 1 (G1) patients.
  • To identify opportunities and challenges associated with implementing novel antiviral therapies in the post-transplant setting.

Main Methods:

  • Overview of existing literature on antiviral treatments for recurrent hepatitis C virus post-liver transplantation.
  • Analysis of the efficacy, tolerability, and response rates of current therapies (pegylated interferon and ribavirin).
  • Examination of the emerging landscape of directly acting antivirals (DAAs) for hepatitis C virus genotype 1.

Main Results:

  • Hepatitis C virus recurrence post-transplant leads to recurrent cirrhosis in 20-30% of patients within 5 years.
  • Current standard therapies achieve sustained virologic response in only about 30% of patients.
  • Successful eradication of hepatitis C virus is the sole identified factor linked to improved survival post-liver transplantation.

Conclusions:

  • Hepatitis C virus recurrence remains a critical challenge in liver transplantation, necessitating improved therapeutic approaches.
  • Directly acting antivirals represent a promising advancement, offering potentially higher response rates and better tolerability for G1 HCV patients.
  • Further research and clinical implementation are crucial to optimize the use of DAAs and improve long-term outcomes for liver transplant recipients.

Keywords:
BoceprevirDAAFibrosisHCVHepatitis C virusLADRLTLiver transplantationLow accelerating dose regimenPEG-IFNPIPRPegylated interferonRRibavirinTelaprevirdirectly acting antiviralshepatitis C virusliver transplantationlow accelerating dose regimenpegylated interferonpegylated interferon and ribavirinprotease inhibitorribavirin

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