Published online Mar 27, 2015. doi: 10.4254/wjh.v7.i3.532
Peer-review started: August 29, 2014
First decision: September 30, 2014
Revised: October 21, 2014
Accepted: December 16, 2014
Article in press: December 16, 2014
Published online: March 27, 2015
The first interferon-free regimens have been approved for the treatment of patients with chronic hepatitis C virus (HCV). In the liver transplant (LT) setting, these regimens are expected to have an important effect, because graft loss due to HCV recurrence is a serious problem after LT. The response to the hitherto conventional treatment with pegylated interferon and ribavirin is poor. The significantly better response rates achieved with boceprevir-based and telaprevir-based triple therapy have led to better graft and patient survival rates, but severe drug interactions with immunosuppressants limit the feasibility of this therapy for LT patients. With the approval of sofosbuvir in January 2014, of simeprevir in May 2014, and of daclatasvir in August 2014, three antiviral agents are now available and promise to be applicable without relevant adverse effects or negative interactions with immunosuppressants. Thus, 2014 marks the beginning of a new era of treatment options for HCV recurrence after LT. Although safety and efficacy studies of several interferon-free regimens for patients with HCV recurrence after LT have achieved good preliminary results, reports of clinical experiences with LT patients are scarce. The lack of randomized studies, the small number of enrolled and carefully selected patients, and the heterogeneity of these studies make the results questionable. Real-life experiences are eagerly awaited so that clinicians can estimate the usefulness and the pitfalls of these new regimens. Additionally, the high costs of these agents may limit their accessibility for many patients. The aim of this review is to summarize the current experience with and the expectations of the new direct-acting antiviral agents for LT patients.
Core tip: In the liver transplant (LT) setting, graft loss due to hepatitis C virus (HCV) recurrence is a serious problem after LT. The former conventional treatment with pegylated interferon and ribavirin is unsatisfying, due to poor response rates and tolerability. With the first interferon-free regimens that are currently being approved for the treatment of patients with chronic HCV, 2014 marks the beginning of a new era of treatment options for HCV recurrence after LT. This review summarizes the current experience with and the expectations of the new direct-acting antiviral agents in the setting of LT.