Management of Hepatitis C Post-liver Transplantation: a Comprehensive Review

Abstract

Infection with hepatitis C virus (HCV) is a common cause of chronic liver disease, and HCV-related cirrhosis and hepatocellular carcinoma are the leading causes for liver transplantation in the Western world. Recurrent infection of the transplanted liver allograft is universal in patients with detectable HCV viremia at the time of transplant and can cause a spectrum of disease, ranging from asymptomatic chronic infection to an aggressive fibrosing cholestatic hepatitis. Recurrent HCV is more aggressive in the post-transplant population and is a leading cause of allograft loss, morbidity, and mortality. Historically, treatment of recurrent HCV has been limited by low rates of treatment success and high side effect profiles. Over the past few years, promising new therapies have emerged for the treatment of HCV that have high rates of sustained virological response without the need for interferon based regimens. In addition to being highly effective, these treatments have higher rates of adherence and a lower side effect profile. The purpose of this review is to summarize current therapies in recurrent HCV infection, to review the recent advances in therapy, and to highlight areas of ongoing research.

A Metabolomics Signature Linked To Liver Fibrosis In The Serum Of Transplanted Hepatitis C Patients

“…According to this study, survival rates were significantly higher in patients with high baseline BTR. This affirmation is coherent with our results since the patients with advanced fibrosis after liver transplantation have smaller survival expectations and may develop HCC 58 .…”

Oral Direct-Acting Agent Therapy for Hepatitis C Virus Infection

“…Infection with HCV is the primary indication for liver transplantation and causes more deaths than all other notifiable infectious diseases in the United States combined (3, 4). Cure of this infection, defined as the absence of detectable HCV RNA in the blood at least 12 weeks after treatment completion (sustained virologic response [SVR]), is strongly associated with reduced liver-related morbidity and mortality (5, 6).…”

Recidivada Hepatite C Após Transplante De Fígado

“…Clinical decompensation was defined as the occurrence of ascites with or without peripheral edema, hydrothorax, varicose veins bleeding, spontaneous bacterial peritonitis, or encephalopathy during the follow-up. Studies on the evolution of cirrhosis in the graft agree upon the fact that the recurrence of HCV infection causes hepatic failure in a great amount of patients, and the progression period is shorter than in the non-immunosuppressed patients (15) . Several risk factors for development of recurrent chronic HCV after liver transplantationhavebeen discussed, including recipient and donor factors.…”

“…The lack of sufficient sensibility and specificity of the viral factors does not allow them to be used to determine which patients should be subjected to liver transplant and which ones should be given a preventive antiviral therapy. This is also true for the variables regarding the receptor, including age, gender, and ethnicity (15) . Among donor factors, it is important to emphasize that several studies confirm the relation between the advanced donor age with a earlier and more severe histological progression of the HCV recurrence and a decrease in survival of recipients (16) .Even though the median age of liver donor in the present study was 34.5 years, there was a considerable variability with the maximum age being 67 years.…”