Management of posttransplant hepatitis C infection

Aytaman, Ayse; Kaufman, Marina; Terrault, Norah A.

doi:10.1097/mot.0b013e3283398237

Cited by 19 publications

(14 citation statements)

References 98 publications

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“…These programs were life-saving for LT patients, many of whom would have died without these early access programs, given the rapid progression from decompensated to death seen in LT patients with recurrent decompensated cirrhosis. [3,5,31,43] ]. As in the nontransplant setting, treatment with protease inhibitor based regimens is not recommended because of safety concerns.…”

Section: Posttransplant Hepatitis C Virus Treatment In Decompensated mentioning

confidence: 99%

“…Prior cohort studies from the interferon-based treatment era established that viral eradication with HCV therapy improved post-LT survival, but the achievement of a sustained virological response (SVR) was challenging because of limited efficacy and poor tolerability [5]. Thus, the pre-and post-LT populations were viewed as two of the most difficult-to-treat groups.…”

mentioning

confidence: 97%

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Perspectives on treating hepatitis C infection in the liver transplantation setting

Chen

Terrault²

2016

Current Opinion in Organ Transplantation

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Section: Posttransplant Hepatitis C Virus Treatment In Decompensated mentioning

confidence: 99%

mentioning

confidence: 97%

Perspectives on treating hepatitis C infection in the liver transplantation setting

Chen

Terrault²

2016

Current Opinion in Organ Transplantation

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“…Possible underlying mechanisms include HIV-mediated immune activation and dys-regulation, inadequate immunosuppression due to DDIs between ART medications and immunosuppressants, and crossreactivity with subsequent hepatocellular injury from memory alloreactive T cells generated from exposure to prior infections such as cytomegalovirus [7,29]. Importantly, in the setting of HCV infection, treatment of acute rejection has been associated with progression of fibrosis and poorer graft and patient survival [30,31]. …”

Section: Liver Transplantation Outcomes In Hiv-infected Patientsmentioning

confidence: 99%

Hepatitis C virus–HIV-coinfected patients and liver transplantation

Kardashian

Price²

2015

Current Opinion in Organ Transplantation

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Purpose of review To review the experience to date and unique challenges associated with liver transplantation in hepatitis C virus (HCV)/HIV-coinfected patients. Recent findings The prevalence of cirrhosis and hepatocellular carcinoma is rising among HIV-infected individuals. With careful patient selection and in the absence of HCV infection, HIV-infected and HIV-uninfected liver transplant recipients have comparable posttransplant outcomes. However, in the presence of HCV infection, patient and graft survival are significantly poorer in HIV-infected recipients, who have a higher risk of aggressive HCV recurrence, acute rejection, sepsis, and multiorgan failure. Outcomes may be improved with careful recipient and donor selection and with the availability of new highly potent all-oral HCV direct acting antivirals (DAAs). Although all-oral DAAs have not been evaluated in HIV/HCV-coinfected transplant patients, HIV does not adversely impact treatment success in nontransplant populations. Therefore, there is great hope that HCV can be successful eradicated in HIV/HCV-coinfected transplant patients and will result in improved outcomes. Careful attention to drug–drug interactions with HIV antiretroviral agents, DAAs, and posttransplant immunosuppressants is required. Summary Liver transplant outcomes are poorer in HIV/HCV-coinfected recipients compared with those with HCV-monoinfection. The new HCV DAAs offer tremendous potential to improve outcomes in this challenging population.

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“…Around 50% of non-transplant patients who are difficult to treat because of the presence of factors predicting a lack of response have been shown to experience a greater sustained viral response (Aymant et, 2010). In transplanted patients, the increase in efficacy, applicability and tolerance, and the possible interactions with other drugs are as yet unknown and more studies are still required.…”

Section: New Therapies For Hcvmentioning

confidence: 99%

“…In all cases management should be personalized, and consideration given to such factors as renal function, concomitant diabetes, a prior history of rejection and genotype (Aymant et al, 2010).…”

Section: Late Post-transplant Antiviral Therapymentioning

confidence: 99%