Review article: the treatment of hepatitis C virus recurrence after liver transplantation.
BACKGROUND
Recurrent hepatitis C represents a major challenge for the liver transplant community. Given the potentially significant impact that hepatitis C recurrence has on graft and patient survival, several treatment strategies have been utilized to prevent/slow the progression to hepatitis C-related graft failure.


OBJECTIVE
To review the efficacy and applicability of treatment strategies for managing recurrent hepatitis C.


METHODS
Search of MEDLINE (1990 to December 2006) and national meeting abstracts. Search terms included hepatitis C, liver transplantation, treatment, sustained virological response (SVR), and end of treatment virological response. An emphasis was placed on randomized trials.


RESULTS
The largest study of treatment prior to liver transplantation (n = 124) achieved SVR in 24%. Eight randomized trials (n = 383) examined the efficacy of preemptive therapy with SVR ranging from 0-33%. Eligibility for treatment was low and dose reduction common. Four randomized trials (n = 245; all abstracts) have reported SVR from 33-42% for treating those with histological evidence of recurrent disease.


CONCLUSIONS
Therapies for treating hepatitis C recurrence have limited applicability and tolerability, and they have a low SVR. Based on available results, preemptive therapy is not recommended. Pegylated interferon and ribavirin is currently the preferred choice for treating established recurrence. There is an urgent need for safer and more effective anti-viral therapy in this situation.
Arjal
R R
RR
Division of Gastroenterology and Hepatology, University of Colorado at Denver and Health Sciences Center, Denver, CO 80262, USA.
Burton
J R
JR
Villamil
F
F
Rosen
H R
HR
D000998:Antiviral Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D008099:Liver / Q000473:pathology / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012254:Ribavirin / Q000627:therapeutic use; D012307:Risk Factors; D016896:Treatment Outcome
D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons