Prevention and Treatment of Recurrent Hepatitis C after Liver Transplantation

Hepatitis C virus (HCV) is the leading indication for liver transplantation in the United States. Recurrent HCV infection after transplant is nearly universal, and the disease course is accelerated. In select patients, pre-transplant antiviral therapy can be given with the aim of preventing recurrent infection. The more common strategy for managing recurrent HCV, however, is post-transplant antiviral therapy with the aim of achieving sustained virologic response. The limited efficacy and poor tolerability of pegylated-interferon and ribavirin among patients with cirrhosis or after liver transplant have been major barriers to preventing or treating recurrent HCV. Preliminary results suggest that virologic response in this patient population is improved with protease inhibitor (PI)-based triple therapy. Although the efficacy of this regimen at preventing or treating recurrent HCV remains to be seen, serious adverse events are frequent when PI-triple therapy is used in the transplant setting. More tolerable and effective treatment regimens are desperately needed in this patient population.