Published online Jan 28, 2016. doi: 10.3748/wjg.v22.i4.1650
Peer-review started: July 31, 2015
First decision: August 31, 2015
Revised: September 20, 2015
Accepted: November 24, 2015
Article in press: November 24, 2015
Published online: January 28, 2016
Hepatitis C virus (HCV) infection is estimated to affect 130-150 million people globally which corresponds to 2%-3% of the total world population. It remains the leading indication for liver transplant worldwide and has been demonstrated to negatively impact both patient and graft survival following non-hepatic organ transplantation. In the era of interferon-based therapy, although treatment and cure of HCV prior to non-hepatic transplant improved survival, tolerability and low cure rates substantially limited therapy. Interferon (IFN)-based therapy following non-hepatic solid organ transplant, due to the risk of allograft rejection, is generally contraindicated. Rapid advances in IFN-free therapy with direct acting antivirals (DAAs) in the last few years have completely changed the paradigm of hepatitis C therapy. Compared to IFN-based regimens, DAAs have less frequent and less severe adverse effects, shorter durations of therapy, and higher cure rates that are minimally impacted by historically negative predictors of response such as cirrhosis, ethnicity, and post-transplant state. Recent studies have shown that liver transplant (LT) recipients can be safely and effectively treated with DAA combination therapies; although data are limited, many of the principles of therapy in LT may be extrapolated to non-hepatic solid organ transplant recipients. Here we review the data on DAA combination therapies in transplantation, discuss the advantages and disadvantages of pre- vs post-transplant HCV therapy and future directions.
Core tip: Direct acting antiviral (DAA) therapy has the potential to eliminate hepatitis C virus (HCV) from the population of organ transplant candidates and recipients and thereby the negative impact of HCV on outcomes. Among non-hepatic organ transplant patients, the biggest barriers currently are limited safety and efficacy data in this population, particularly in those with advanced renal disease, and global variability of access and reimbursement for DAAs. Future research is needed to better assess safety, efficacy and impact of DAA therapy in non-hepatic solid organ transplant, as well as to explore the safety of using HCV infected donors, with prophylactic therapy, to expand the donor pool.