title: Hepatitis C virus reinfection after liver transplantation: is there a role for direct antiviral agents?
abstract: Recurrence of hepatitis C virus (HCV) infection following liver transplantation (LT) is almost universal and can accelerate graft cirrhosis in up to 30% of patients. The development of effective strategies to treat or prevent HCV recurrence after LT remains a major challenge, considering the shortage of donor organs and the accelerated progression of HCV in LT recipients. Standard antiviral therapy with pegylated-interferon plus ribavirin is the current treatment of choice for HCV LT recipients, even though the combination is not as effective as it is in immunocompetent patients. A sustained virological response in the setting of LT improves patient and graft survival, but this is only achieved in 30%-45% of patients and the treatment is poorly tolerated. To improve the efficacy of pre- and post-transplant antiviral therapy, a new class of potent direct-acting antiviral agents (DAAs) has been developed. The aim of this review is to summarize the use of DAAs in LT HCV patients. PubMed, Cochrane Library, MEDLINE, EMBASE, Web of Science and clinical trial databases were searched for this purpose. To date, only three clinical studies on the topic have been published and most of the available data are in abstract form. Although a moderately successful early virological response has been reported, DAA treatment regimens were associated with severe toxicity mitigating their potential usefulness. Moreover, the ongoing nature of data, the lack of randomized studies, the small number of enrolled patients and the heterogeneity of these studies make the results largely anecdotal and questionable. In conclusion, large well-designed clinical studies on DAAs in HCV LT patients are required before these drugs can be recommended after transplantation.
authors: Marco Dall'Agata, Annagiulia Gramenzi, Maurizio Biselli, Mauro Bernardi, Semeiotica Medica - Policlinico S. Orsola-Malpighi, Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, 40138 Bologna, Italy.
authors: Marco
authors: M
authors: Dall'Agata
authors: Marco Dall'Agata, Annagiulia Gramenzi, Maurizio Biselli, Mauro Bernardi, Semeiotica Medica - Policlinico S. Orsola-Malpighi, Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, 40138 Bologna, Italy.
authors: Annagiulia
authors: A
authors: Gramenzi
authors: Marco Dall'Agata, Annagiulia Gramenzi, Maurizio Biselli, Mauro Bernardi, Semeiotica Medica - Policlinico S. Orsola-Malpighi, Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, 40138 Bologna, Italy.
authors: Maurizio
authors: M
authors: Biselli
authors: Marco Dall'Agata, Annagiulia Gramenzi, Maurizio Biselli, Mauro Bernardi, Semeiotica Medica - Policlinico S. Orsola-Malpighi, Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, 40138 Bologna, Italy.
authors: Mauro
authors: M
authors: Bernardi
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016174:Hepacivirus / Q000187:drug effects* / Q000472:pathogenicity; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects*; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents
keywords: Direct antiviral agents; Hepatitis C virus; Immunosuppressive agents; Liver transplantation; Peginterferon/ribavirin