Systematic review: anti-viral therapy of recurrent hepatitis C after liver transplantation

Abstract

International audienceBackground Hepatitis C viral infection is the first cause of liver transplantation worldwide. Recurrence of infection is constant and compromises patient and graft survival. Aim To provide an updated review of the main treatments of recurrent HCV. Methods MEDLINE (1990 to August 2010) and national meeting abstract search. Search terms included hepatitis C, liver transplantation, treatment. An emphasis was placed on randomized trials. Results Antiviral therapy based on pegylated interferon and ribavirin must be considered before liver transplantation but is poorly tolerated and has poor results in patients with cirrhosis and end-stage liver disease. Antiviral therapy can be administrated systematically early after liver transplantation, or in patients with established recurrent chronic hepatitis. Combination of pegylated interferon alfa plus ribavirin results in a sustained virological response of up to 30% in patients. Small trial of polyclonal anti-HCV to prevent recurrence were disappointing. Perspective Currently available antiviral therapy is effective in a minority of transplanted patients infected with HCV. Specifically targeted antiviral therapies combining interferon alfa and ribavirin or a combination of antiprotease and antipolymerase components associated with a genetic prediction of antiviral response and blocking HCV cell entry should improve the long-term prognosis of recurrent hepatitis C in the near future