Management of hepatitis C infection before and after liver transplantation.
Chronic hepatitis C (CHC) is the most common indication for liver transplantation (LT). Aggressive treatment of hepatitis C virus (HCV) infection before cirrhosis development or decompensation may reduce LT need and risk of HCV recurrence post-LT. Factors associated with increased HCV risk or severity of recurrence include older age, immunosuppression, HCV genotype 1 and high viral load at LT. HCV recurrence post-LT leads to accelerated liver disease and cirrhosis development with reduced graft and patient survival. Currently, interferon (IFN)-based regimens can be used in dual-agent regimens with ribavirin, in triple-agent antiviral strategies with direct-acting antivirals (e.g., protease inhibitors telaprevir or boceprevir), or before transplant in compensated patients to reduce HCV viral load to prevent or reduce the risk of post-LT recurrence and complications; they cannot be used in patients with decompensated cirrhosis. IFN-based regimens are used in less than half of HCV-infected patients waiting for LT due to extremely low efficacy and poor tolerability. However, antiviral therapy is indicated after LT in patients with histologically confirmed CHC despite tolerability issues. Improvements in side effect management have increased survival in patients achieving therapeutic targets. HCV treatment pre- and post-LT results in significant health care costs especially when lack of efficacy leads to disease worsening, although studies have shown sofosbuvir treatment before LT vs conventional post-LT dual antiviral is cost effective. The suboptimal efficacy and tolerability of IFN-based therapies, plus the significant economic burden, means the need for effective and well tolerated IFN-free anti-HCV therapy for pre- and post-LT remains high.
Stefano Fagiuoli, Maria Grazia Lucà, Anna Baldan, Silvia Pecere, Luisa Pasulo, Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Stefano
S
Fagiuoli
Stefano Fagiuoli, Maria Grazia Lucà, Anna Baldan, Silvia Pecere, Luisa Pasulo, Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Roberto
R
Ravasio
Stefano Fagiuoli, Maria Grazia Lucà, Anna Baldan, Silvia Pecere, Luisa Pasulo, Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Maria Grazia
MG
Lucà
Stefano Fagiuoli, Maria Grazia Lucà, Anna Baldan, Silvia Pecere, Luisa Pasulo, Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Anna
A
Baldan
Stefano Fagiuoli, Maria Grazia Lucà, Anna Baldan, Silvia Pecere, Luisa Pasulo, Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Silvia
S
Pecere
Stefano Fagiuoli, Maria Grazia Lucà, Anna Baldan, Silvia Pecere, Luisa Pasulo, Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Alessandro
A
Vitale
Stefano Fagiuoli, Maria Grazia Lucà, Anna Baldan, Silvia Pecere, Luisa Pasulo, Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Luisa
L
Pasulo
D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D016527:Drug Costs; D004359:Drug Therapy, Combination; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000601:surgery* / Q000821:virology; D016174:Hepacivirus / Q000187:drug effects* / Q000254:growth & development / Q000276:immunology; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000276:immunology / Q000401:mortality; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D018579:Patient Selection; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects*
D000998:Antiviral Agents; D007166:Immunosuppressive Agents
Chronic hepatitis C; Decompensated cirrhosis; Hepatitis C virus; Interferon-free treatment; Orthotopic liver transplantation