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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Clin+Transl+Hepatol
2014 ; 2
(2
): 124-33
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Management of Hepatitis C Before and After Liver Transplantation in the Era of
Rapidly Evolving Therapeutic Advances
#MMPMID26357623
Bunchorntavakul C
; Reddy KR
J Clin Transl Hepatol
2014[Jun]; 2
(2
): 124-33
PMID26357623
show ga
Management of hepatitis C (HCV) in liver transplantation (LT) population presents
unique challenges. Suboptimal graft survival in HCV+ LT recipients is
attributable to universal HCV recurrence following LT. Although eradication of
HCV prior to LT is ideal for the prevention of HCV recurrence it is often limited
by adverse events, particularly in patients with advanced cirrhosis. Antiviral
therapy in LT candidates needs careful monitoring, and prophylaxis with HCV
antibodies is ineffective. Early antiviral therapy after LT has been
investigated, but no clear benefit has been demonstrated. Protocol liver biopsy
is generally recommended in HCV+ LT recipients, and antiviral therapy can be
considered in those with severe/progressive HCV recurrence. Sustained virological
response (SVR) can be achieved in approximately 30% of LT recipients with
pegylated interferon/ribavirin (PEG-IFN/RBV) with survival benefit, but adverse
effects are common. Favorable patient characteristics for response to therapy
include non-1 genotype, previously untreated, low baseline HCV-RNA, and donor
IL28B genotype CC. Direct acting antiviral (DAA)-based triple therapy is
associated with higher rates of SVR, but with similar or slightly higher rates of
side effects, and immunosuppressive regimens need to be closely monitored and
adjusted during the treatment period. Notably, the safety and efficacy of HCV
treatment are very likely to improve with newer generation DAA. The benefit of
immunosuppressive strategy on the natural history HCV recurrence has not been
well elucidated. Based upon available evidence, cyclosporine A (CSA),
mycophenolate mofetil (MMF), and sirolimus appear to have a neutral or small
beneficial impact on HCV recurrence. Donor interleukin 28 B (IL28B) polymorphisms
appear to impact the course and treatment outcomes in recurrent HCV.
Retransplantation should be considered for patients with reasonable survival
probability.