Published online Jun 28, 2015. doi: 10.4254/wjh.v7.i12.1606
Peer-review started: December 13, 2014
First decision: January 8, 2015
Revised: May 18, 2015
Accepted: June 1, 2015
Article in press: June 2, 2015
Published online: June 28, 2015
The first generation direct antiviral agents (DAAs) highlighted substantial prognosis improvement among liver transplant (LT) candidates and recipients with recurrent hepatitis C virus (HCV) infection. During 2014, second generation DAAs are associated with high sustained virological response rates (> 95%), shortened duration courses and relatively few toxicities. In keeping with the currently available data, patients with decompensated cirrhosis awaiting LT is preferable to be treated with interferon-free, new generation DAAs, with or without ribavirin combinations. Although data about the safety of new DAAs combinations in this patient population are limited, sofosbuvir and daclatasvir pharmacokinetics do not appear to change significantly in moderate or severe liver impairment, while other new DAAs (simeprevir, asunaprevir) seem to be contraindicated in patients with severe liver impairment (Child-Pugh class C). On the other hand, sofosbuvir should not be given in patients with glomerular filtration rate ≤ 30 mL/min, but ongoing trials will clarify better this issue. With the objective that newer antiviral combinations will yield safer and more efficient manipulation of HCV recurrence post-transplant, the European Association for the Study of the Liver has recently updated its recommendations towards this direction. Nevertheless the new antivirals’ high cost may be the biggest challenge to their implementation worldwide.
Core tip: Treatment landscape for liver transplant (LT) candidates and recipients with chronic hepatitis C is rapidly shifting due to novel updated data on direct antiviral agents (DAAs); Patients with decompensated cirrhosis awaiting LT should be treated with the interferon (IFN)-free, new generation DAAs, with or without ribavirin (RBV) regimens; IFN-free combinations of sofosbuvir with other novel DAAs with or without RBV led to remarkable on-treatment virological response along with minimal adverse effects “on difficult to treat” LT recipients with recurrent hepatitis C - those with chronic hepatitis C genotype 1, decompensated cirrhosis with Child-Pugh stage B and C as well as previously intolerant or non responsive to IFN therapy; Evidence regarding the efficacy and safety of novel combinative treatments although are very promising, refer still to patients case series.