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World J Gastroenterol. Jul 28, 2014; 20(28): 9253-9260
Published online Jul 28, 2014. doi: 10.3748/wjg.v20.i28.9253
Hepatitis C virus reinfection after liver transplantation: Is there a role for direct antiviral agents?
Marco Dall’Agata, Annagiulia Gramenzi, Maurizio Biselli, Mauro Bernardi
Marco Dall’Agata, Annagiulia Gramenzi, Maurizio Biselli, Mauro Bernardi, Semeiotica Medica - Policlinico S. Orsola-Malpighi, Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, 40138 Bologna, Italy
Author contributions: All authors contributed equally to this work; Dall’Agata M, Gramenzi A and Biselli M put forward the conception and design of the work, acquisition of data, analysis and interpretation of data, drafting and revision of the manuscript, work supervision, approval of the final version of the manuscript; Bernardi M contributed to conception of the work, interpretation of data, drafting and revision of the manuscript, work supervision, approval of the final version of the manuscript.
Correspondence to: Mauro Bernardi, MD, Professor, Director, Semeiotica Medica - Policlinico S. Orsola-Malpighi, Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy. mauro.bernardi@unibo.it
Telephone: +39-51-6362939 Fax: +39-51-6362930
Received: October 15, 2013
Revised: March 27, 2014
Accepted: June 2, 2014
Published online: July 28, 2014
Abstract

Recurrence of hepatitis C virus (HCV) infection following liver transplantation (LT) is almost universal and can accelerate graft cirrhosis in up to 30% of patients. The development of effective strategies to treat or prevent HCV recurrence after LT remains a major challenge, considering the shortage of donor organs and the accelerated progression of HCV in LT recipients. Standard antiviral therapy with pegylated-interferon plus ribavirin is the current treatment of choice for HCV LT recipients, even though the combination is not as effective as it is in immunocompetent patients. A sustained virological response in the setting of LT improves patient and graft survival, but this is only achieved in 30%-45% of patients and the treatment is poorly tolerated. To improve the efficacy of pre- and post-transplant antiviral therapy, a new class of potent direct-acting antiviral agents (DAAs) has been developed. The aim of this review is to summarize the use of DAAs in LT HCV patients. PubMed, Cochrane Library, MEDLINE, EMBASE, Web of Science and clinical trial databases were searched for this purpose. To date, only three clinical studies on the topic have been published and most of the available data are in abstract form. Although a moderately successful early virological response has been reported, DAA treatment regimens were associated with severe toxicity mitigating their potential usefulness. Moreover, the ongoing nature of data, the lack of randomized studies, the small number of enrolled patients and the heterogeneity of these studies make the results largely anecdotal and questionable. In conclusion, large well-designed clinical studies on DAAs in HCV LT patients are required before these drugs can be recommended after transplantation.

Keywords: Hepatitis C virus, Liver transplantation, Direct antiviral agents, Peginterferon/ribavirin, Immunosuppressive agents

Core tip: Considering the increasing shortage of donor organs and the accelerated progression of hepatitis C (HCV) in liver transplant recipients, the development of effective strategies to treat HCV recurrence are of paramount importance. The new classes of direct antiviral agents (DAAs) improved the results of antiviral therapy in HCV-infected immunocompetent patients. The aim of this review was to identify and summarize the potential benefit of DAAs in the liver transplant setting.