Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2016; 22(41): 9044-9056
Published online Nov 7, 2016. doi: 10.3748/wjg.v22.i41.9044
Concise review: Interferon-free treatment of hepatitis C virus-associated cirrhosis and liver graft infection
Nina Weiler, Stefan Zeuzem, Martin-Walter Welker
Nina Weiler, Stefan Zeuzem, Martin-Walter Welker, Universitätsklinikum Frankfurt, Medizinische Klinik 1, 60590 Frankfurt, Germany
Author contributions: Weiler N and Welker MW contributed to literature research and wrote the paper; Zeuzem S revised the paper.
Conflict-of-interest statement: Weiler N, Consultancies/speaker’s bureau for Astellas, Novartis; Zeuzem S, Consultancies/speaker’s bureau for Abbvie, BMS, Gilead, Janssen, Merck; Welker MW, Consultancies/speaker’s fees: AbbVie, Amgen, Bayer, BMS, Gilead, Novartis, Roche. Travel Support: AbbVie, Astellas, Bayer, BMS, Novartis, Janssen, Roche.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Martin-Walter Welker, MD, Universitätsklinikum Frankfurt, Medizinische Klinik 1, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. welker@med.uni-frankfurt.de
Telephone: +49-69-63016557 Fax: +49-69-63015716
Received: May 14, 2016
Peer-review started: May 17, 2016
First decision: July 12, 2016
Revised: August 9, 2016
Accepted: October 19, 2016
Article in press: October 19, 2016
Published online: November 7, 2016
Processing time: 175 Days and 20.8 Hours
Abstract

Chronic hepatitis C is a major reason for development of cirrhosis and hepatocellular carcinoma and a leading cause for liver transplantation. The development of direct-acting antiviral agents lead to (pegylated) interferon-alfa free antiviral therapy regimens with a remarkable increase in sustained virologic response (SVR) rates and opened therapeutic options for patients with advanced cirrhosis and liver graft recipients. This concise review gives an overview about most current prospective trials and cohort analyses for treatment of patients with liver cirrhosis and liver graft recipients. In patients with compensated cirrhosis Child-Pugh-Turcotte (CTP) class A, all approved agents are safe and SVR rates do not significantly differ from patients without cirrhosis in general. In patients with decompensated cirrhosis CTP class B or C, daclastasvir, ledipasvir, velpatasvir, and sofosbuvir are approved, and SVR rates higher than 90% can be achieved. Especially for patients with a model of end stage liver disease score higher than 15 and therefore eligible for liver transplantation, data is scarce. Reported SVR rates in patients with cirrhosis CTP class C are lower compared to patients with a less severe liver disease. In liver transplant recipients with a maximum of CTP class A, SVR rates are comparable to patients without LT. Patients with decompensated graft cirrhosis should be treated on an individual basis.

Keywords: Hepatitis C; Cirrhosis; Liver transplantation; Direct antiviral agents; Interferon-free antiviral treatment

Core tip: Chronic hepatitis C is a major reason for development of cirrhosis and a leading cause for liver transplantation. The development of direct-acting antiviral agents (DAA) offered new therapeutic options for patients with advanced cirrhosis and liver graft recipients. This review gives a high topical summary of most current therapeutic options of DAA-based antiviral therapy in patients with hepatitis C virus associated cirrhosis before and after liver transplantation.