title: Hepatitis C virus and liver transplantation: where do we stand?
abstract: The hepatitis C virus (HCV) infects more than 180 million people globally, with increasing incidence, especially in developing countries. HCV infection frequently progresses to liver cirrhosis leading to liver transplantation or death, and HCV recurrence still constitutes a major challenge for the transplant team. Antiviral therapy is the only available instrument to slow down this process, although its actual impact on liver histology, in responders and nonresponders, is still controversial. We are now facing a "new era" of direct antiviral agents that is already changing the approach to HCV burden both in the pre- and in the post-liver transplantation settings. Available data on sofosbuvir/ledipasvir and sofosbuvir/simeprevir in patients with decompensated cirrhosis sustain a SVR12 of 89% , but one-third of patients do not clinically improved. The sofosbuvir/ribavirin treatment in stable cirrhotic patients with HCC before liver transplantation is associated with 2% recurrence rate if liver transplantation is performed at least one month after undetectable HCV-RNA is achieved. The treatment of recurrence with the new antiviral drugs is associated with a SVR that ranges between 60 and 90%. In this review, we have focused on the evolution of antiviral therapy for HCV recurrence from the "old" interferon-based therapy to the "new" interferon-free regimens, highlighting useful information to aid the transplant hepatologist in the clinical practice.
authors.affiliation: Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
authors.affiliation: Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.|Centre Hepato-Biliaire Paul Brousse, Villejuif, France.
authors.forename: Eleonora
authors.initials: E
authors.lastname: De Martin
authors.affiliation: Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zanetto
authors.affiliation: Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Senzolo
authors.affiliation: Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.
authors.forename: Francesco Paolo
authors.initials: FP
authors.lastname: Russo
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zanus
authors.affiliation: Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fagiuoli
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D016174:Hepacivirus; D006526:Hepatitis C / Q000188:drug therapy* / Q000209:etiology / Q000821:virology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000209:etiology; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence; D014019:Tissue Donors
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D012367:RNA, Viral
keywords: HCV recurrence; antiviral therapy; direct antiviral agents; liver fibrosis; liver transplantation