Elsevier

Transplantation Proceedings

Volume 46, Issue 9, November 2014, Pages 3100-3103
Transplantation Proceedings

24th Congress of the Spanish Liver Transplantation Society
Complication
Hepatitis C Virus Recurrence After Liver Transplantation: How to Treat and When

https://doi.org/10.1016/j.transproceed.2014.09.177Get rights and content

Abstract

Chronic hepatitis C (CHC) is an important cause of cirrhosis and hepatocellular carcinoma and a common indication of liver transplantation (LT). Recurrence of hepatitis C occurs universally after LT with an accelerated course of the natural history of CHC in the graft. Treatment of hepatitis C before transplantation is the most effective strategy because it prevents graft reinfection, but applicability is low with pegylated interferon regimens. Treatment after LT is the strategy more frequently used. A sustained viral response (SVR) is achieved by one-third of those treated with dual therapy and is associated with better outcomes after LT. Triple therapy with protease inhibitors after LT has efficacy to 60%–70% of SVR but is associated with higher rates of secondary effects and drug-drug interactions that require an intensified and frequent monitoring of calcineurin inhibitors during treatment. In the near future, interferon-free regimens with new oral antiviral drugs will likely prevent viral reinfection before or after LT, and shorter treatment regimens and less toxicity are expected.

Section snippets

The Time to Treat HCV Recurrence

Two strategies can be used in these patients: (i) pre-transplantation antiviral therapy with the intention of preventing HCV infection after LT; and (ii) post-transplantation antiviral therapy given with the intent of eradicating the virus in those with established viral or histologic recurrence. The most effective treatment to prevent HCV recurrence is to treat HCV infection before LT. However, this strategy can be used in very few candidates, with compensated cirrhosis or mild decompensated

Results of Antiviral Treatment With Peg-IFN and RBV

Studies with the “preemptive approach” have shown that this strategy is seldom applicable owing to the frequent development of side effects and low proportion of patients in whom therapy can be started because of preexisting conditions such anemia, neutropenia, and thrombocytopenia, with results in terms of SVR of ∼20% [10], [11]. Studies with peg-IFN and RBV given when the disease is established, or the “delayed” approach, is the strategy that has been used in most studies. Antiviral treatment

Treatment of HCV Recurrence With Triple Therapy

Triple therapy with protease inhibitors (PI), boceprevir (BOC), and telaprevir (TPV) in the LT setting is now being evaluated, and results regarding efficacy have been published in the past months, most of them in abstract form. First reports have shown early viral response rates of 60%–100% [17]. Werner et al reported the experience in 12 patients. Eight patients at week 12 of treatment were HCV-RNA negative [18]. Recently, 3 large international series have shown results of end of treatment

References (27)

  • A. Coilly et al.

    Safety and efficacy of protease inhibitors to treat hepatitis C after liver transplantation. A multicenter experience

    J Hepatol

    (2014)
  • W.R. Kim et al.

    Evolution of liver transplantion in Europe: report of the European Liver Transplant Registry

    Liver Transpl

    (2003)
  • S.A. Taga et al.

    Cholestatic hepatitis C in liver allografts

    Liver Transpl Surg

    (1998)
  • Cited by (0)

    Funding: Instituto de Salud Carlos III (grant # PI13/01770).

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