title: Recurrent HCV after liver transplantation-mechanisms, assessment and therapy.
abstract: Chronic HCV infection is the leading indication for liver transplantation. However, as a result of HCV recurrence, patient and graft survival after liver transplantation are inferior compared with other indications for transplantation. HCV recurrence after liver transplantation is associated with considerable mortality and morbidity. The development of HCV-related fibrosis is accelerated after liver transplantation, which is influenced by a combination of factors related to the virus, donor, recipient, surgery and immunosuppression. Successful antiviral therapy is the only treatment that can attenuate fibrosis. The advent of direct-acting antiviral agents (DAAs) has changed the therapeutic landscape for the treatment of patients with HCV. DAAs have improved tolerability, and can potentially be used without PEG-IFN for a shorter time than previous therapies, which should result in better outcomes. In this Review, we describe the important risk factors that influence HCV recurrence after liver transplantation, highlighting the mechanisms of fibrosis and the integral role of hepatic stellate cells. Indirect and direct assessment of fibrosis, in addition to new antiviral therapies, are also discussed.
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
authors.forename: Deepak
authors.initials: D
authors.lastname: Joshi
authors.affiliation: UCL Institute for Liver and Digestive Health, University College London, Royal Free Hospital Campus U3, Rowland Hill Street, London NW3 2PF, UK.
authors.forename: Massimo
authors.initials: M
authors.lastname: Pinzani
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
authors.forename: Ivana
authors.initials: I
authors.lastname: Carey
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
authors.forename: Kosh
authors.initials: K
authors.lastname: Agarwal
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D005355:Fibrosis; D006085:Graft Survival; D055166:Hepatic Stellate Cells / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation / Q000009:adverse effects*; D012008:Recurrence; D012307:Risk Factors
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers