Hepatitis C recurrence: the Achilles heel of liver transplantation

Abstract

Hepatitis C virus (HCV) infection is the most common indication for liver transplantation worldwide; however, recurrence post transplant is almost universal and follows an accelerated course. Around 30% of patients develop aggressive HCV recurrence, leading to rapid fibrosis progression (RFP) and culminating in liver failure and either death or retransplantation. Despite many advances in our knowledge of clinical risks for HCV RFP, we are still unable to accurately predict those most at risk of adverse outcomes, and no clear consensus exists on the best approach to management. This review presents a critical overview of clinical factors shown to influence the course of HCV recurrence post transplant, with particular focus on recent data identifying the important role of metabolic factors, such as insulin resistance, in HCV recurrence. Emerging data for genetic markers of HCV recurrence and their usefulness for predicting adverse outcomes will also be explored.

Cost-effectiveness of pretransplant sofosbuvir for preventing recurrent hepatitis C virus infection after liver transplantation

“…Recurrent HCV is the most common cause of death and graft loss among patients who undergo LT for HCV‐related cirrhosis, as has been amply reported in the literature and confirmed in the survival analysis in the present study. Liver decompensation occurs more rapidly and in a higher proportion of transplanted than nontransplanted HCV‐positive patients .…”

Prevention of hepatitis C recurrence by bridging sofosbuvir/ribavirin from pre‐ to post‐liver transplant: a real‐life strategy

“…Safe and highly effective oral direct‐acting antiviral (DAA) regimens now available to treat hepatitis C virus (HCV) have revolutionized the management of both liver transplant (LT) candidates and recipients . A major breakthrough of all oral regimens was the chance to treat cirrhotic patients with impaired liver function before LT, in order to prevent HCV reinfection which is a major determinant of anticipated graft loss and early mortality . Sofosbuvir (SOF), a nucleotide analogue inhibitor of the HCV‐RNA‐dependent RNA polymerase (NS5B; Gilead‐Sciences, Foster City, CA), has been approved in 2013 .…”

Daclatasvir, Simeprevir and Ribavirin as a Promising Interferon-Free Triple Regimen for HCV Recurrence after Liver Transplant

“…For immunosuppressed recipients, the recurrence of HCV infection in the allograft is universally characterized by higher viral replication rates and an accelerated disease course [2]. Consequently, graft loss due to HCV recurrence is still a serious problem after LT [3]. The response to treatment with pegylated interferon (PegIFN) and ribavirin (RBV) is poor, with frequent adverse effects and low antiviral effectiveness [4].…”