Management of posttransplant hepatitis C infection.
OBJECTIVE
Chronic hepatitis C virus (HCV) infection is the leading cause of liver transplantation. Outcome of HCV-associated liver transplantation has been worse than transplantation from other causes. This is mostly related to universal recurrence of HCV in the allograft leading to graft and patient loss or retransplantation. Current antiviral therapies (AVTs) are inadequate and ineffective in the vast majority of the patients with intolerable side effects in most. However, a sustained virologic response (SVR) is associated with improved graft and patient survival. New specifically targeted AVTs for HCV (STAT-C) agents in development will significantly improve the success of AVT. This review focuses on recent data in peritransplant management of HCV with special emphasis on predictors of outcome, diagnosis, prevention and control of reinfection with newer treatments on the horizon.


RESULTS
In the immediate pretransplant setting, AVT should be considered in select patients to eradicate the virus. Careful donor selection, immunosuppression (IMS) modulation with steroid and calcineurin inhibitor (CNI) minimization, avoidance of T-cell-depleting treatments and acute rejection episodes, and control of metabolic syndrome can improve allograft outcomes and improve the response to AVT. AVT prior to significant damage to the allograft is strongly recommended.


CONCLUSIONS
With modified novel IMS protocols, careful donor selection, and AVT prior to significant damage to the allograft we can improve the outcome of posttransplant hepatitis C infection. Albeit there are no available data on new antiviral agents, STAT-Cs will have a significant impact in this setting in the near future.
Aytaman
Ayse
A
VA New York Harbor HCS Brooklyn, Brooklyn, New York 11209, USA. Ayse.Aytaman@va.gov
Kaufman
Marina
M
Terrault
Norah A
NA
D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D019698:Hepatitis C, Chronic / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects*; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000998:Antiviral Agents; D007166:Immunosuppressive Agents