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Hepatitis C therapy before and after liver transplantation
Author(s) -
Terrault Norah A.
Publication year - 2008
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21624
Subject(s) - medicine , liver transplantation , ribavirin , tolerability , liver disease , hepatitis c , pegylated interferon , transplantation , hepatitis c virus , discontinuation , immunology , combination therapy , regimen , gastroenterology , virus , adverse effect
Key Points1 Pretransplant therapy, using a low‐accelerating‐dose regimen, is an option for patients with mildly decompensated liver disease and low laboratory Model for End‐Stage Liver Disease scores. Achievement of an on‐treatment virologic response is the goal of therapy. Preliminary data suggest that up to two‐thirds of patients who become hepatitis C virus RNA–negative on treatment will be hepatitis C virus infection–free post‐transplantation. 2 Effective prophylactic therapies are not available. Hepatitis C antibody therapy has been ineffective in preventing hepatitis C virus infection in studies to date. 3 Preemptive antiviral therapy started within weeks of transplantation is limited by tolerability, particularly in patients with high Model for End‐Stage Liver Disease scores pre‐transplantation. Rates of sustained virologic response vary from 8% to 39%. Histological benefits in virologic nonresponders have been demonstrated. 4 Posttransplant antiviral therapy in those with evidence of recurrent disease is the mainstay of management. A combination of pegylated interferon and ribavirin is the treatment of choice, and sustained virologic response is achieved with 48 weeks of treatment in approximately 30% of treated patients. Attainment of early loss of hepatitis C virus RNA is highly predictive of sustained virologic response. Histologic improvements are seen in responders. Survival is prolonged among those achieving a sustained virologic response. 5 Posttransplant antiviral therapy is limited by poor tolerability and the frequent need for dose reductions and/or discontinuation. Immunologic complications, including acute rejection, chronic rejection, and autoimmune‐like hepatitis, occur in association with therapy, albeit at low rates. 6 Hepatitis C virus–infected liver transplant recipients represent an important patient population in need of new therapeutics options to prevent patient and graft losses due to recurrent hepatitis C virus disease.Liver Transpl 14:S58–S66, 2008. © 2008 AASLD.