Treatment of hepatitis C before liver transplantation

Abstract

Hepatitis C recurrence after liver transplantation (LT) is universal and it is characterized by an accelerated course, with 20-30∈% of patients developing liver cirrhosis after 5 years of LT. One of the most attractive approaches to prevent hepatitis C recurrence is by treating hepatitis C before transplantation. The aim of this strategy is to prevent the infection of the new graft, either by achieving sustained virological response, or by attaining on treatment response. Nevertheless, the applicability of this strategy is limited by the high risk of severe adverse events associated with interferon-based treatments in patients with liver dysfunction. In the era of protease inhibitors, triple therapy will most likely increase the current rate of viral clearance, even in patients with cirrhosis, but there is still scarcity of data in patients on the waiting list for a LT. Due to the fact that triple therapy includes interferon, only those patients with compensated liver disease have an indication of therapy. Preliminary data obtained in this sub-population suggest a significant increase in the number of haematological side effects, severe infections and decompensations. Therefore, it is mandatory to carefully select patients to be treated before LT. In a few years from now interferon-free regimens combining direct-acting antiviral agents targeting different hepatitis C viral proteins will most likely replace the current treatment and prevent hepatitis C re-infection in most cases.