Published online Nov 28, 2014. doi: 10.3748/wjg.v20.i44.16409
Revised: August 27, 2014
Accepted: October 14, 2014
Published online: November 28, 2014
Chronic hepatitis C virus (HCV) infection is the leading cause of death from liver disease and the leading indication for liver transplantation (LT) in the United States and Western Europe. LT represents the best therapeutic alternative for patients with advanced chronic liver disease caused by HCV or those who develop hepatocarcinoma. Reinfection by HCV of the graft is universal and occurs in 95% of transplant patients. This reinfection can compromise graft function and patient survival. In a few cases, the histological recurrence is minimal and non-progressive; however, in most patients it follows a more rapid course than in immunocompetent persons, and frequently evolves into cirrhosis with graft loss. In fact, the five-year and ten-year survival of patients transplanted because of HCV are 75% and 68%, respectively, compared with 85% and 78% in patients transplanted for other reasons. There is also a pattern of recurrence that is very severe, but rare (< 10%), called fibrosing cholestatic hepatitis, which often involves rapid graft loss. Patients who present a negative HCV viremia after antiviral treatment have better survival. Many studies published over recent years have shown that antiviral treatment of post-transplant HCV hepatitis carried out during the late phase is the best option for improving the prognosis of these patients. Until 2011, PEGylated interferon plus ribavirin was the standard of care, resulting in a sustained virological response in around 30% of recipients. The addition of protease inhibitors, such as boceprevir or telaprevir, to the standard of care, or the use of other direct-acting antiviral drugs may involve therapeutic changes in the context of HCV recurrence. This may result a better prognosis for these patients, particularly those with severe recurrence or factors predicting rapid progression of fibrosis. However, the use of these agents in LT still requires clarification in terms of safety and efficacy.
Core tip: Chronic hepatitis C virus (HCV) infection is the reason for about 50% of liver transplants in the western world. Reinfection of the graft is universal and can compromise graft function and patient survival. The development of an efficient antiviral therapeutic strategy has been the focus of clinical research in recent years, including when, how much and at what point this treatment should be applied. The introduction of new drugs for the treatment of chronic HCV hepatitis may involve therapeutic changes and, perhaps, a better prognosis for these patients, particularly those with severe recurrence or factors predicting rapid progression of fibrosis.