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World J Hepatol. Mar 27, 2015; 7(3): 532-538
Published online Mar 27, 2015. doi: 10.4254/wjh.v7.i3.532
Hepatitis C virus reinfection after liver transplant: New chances and new challenges in the era of direct-acting antiviral agents
Kerstin Herzer, Guido Gerken
Kerstin Herzer, Guido Gerken, Department of Gastroenterology and Hepatology, University Hospital Essen, 45122 Essen, Germany
Kerstin Herzer, Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, 45122 Essen, Germany
Author contributions: Herzer K wrote the manuscript; Gerken G contributed to the substantial supplementing of the manuscript.
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: Kerstin Herzer, MD, Associate Professor, Department of Gastroenterology and Hepatology, University Hospital Essen, Hufeland str. 55, 45122 Essen, Germany. kerstin.herzer@uk-essen.de
Telephone: +49-201-7235147 Fax: +49-201-723 3393
Received: August 29, 2014
Peer-review started: August 29, 2014
First decision: September 30, 2014
Revised: October 21, 2014
Accepted: December 16, 2014
Article in press: December 16, 2014
Published online: March 27, 2015
Abstract

The first interferon-free regimens have been approved for the treatment of patients with chronic hepatitis C virus (HCV). In the liver transplant (LT) setting, these regimens are expected to have an important effect, because graft loss due to HCV recurrence is a serious problem after LT. The response to the hitherto conventional treatment with pegylated interferon and ribavirin is poor. The significantly better response rates achieved with boceprevir-based and telaprevir-based triple therapy have led to better graft and patient survival rates, but severe drug interactions with immunosuppressants limit the feasibility of this therapy for LT patients. With the approval of sofosbuvir in January 2014, of simeprevir in May 2014, and of daclatasvir in August 2014, three antiviral agents are now available and promise to be applicable without relevant adverse effects or negative interactions with immunosuppressants. Thus, 2014 marks the beginning of a new era of treatment options for HCV recurrence after LT. Although safety and efficacy studies of several interferon-free regimens for patients with HCV recurrence after LT have achieved good preliminary results, reports of clinical experiences with LT patients are scarce. The lack of randomized studies, the small number of enrolled and carefully selected patients, and the heterogeneity of these studies make the results questionable. Real-life experiences are eagerly awaited so that clinicians can estimate the usefulness and the pitfalls of these new regimens. Additionally, the high costs of these agents may limit their accessibility for many patients. The aim of this review is to summarize the current experience with and the expectations of the new direct-acting antiviral agents for LT patients.

Keywords: Hepatitis C virus, Liver transplant, Interferon, Sofosbuvir, Simeprevir, Daclatasvir

Core tip: In the liver transplant (LT) setting, graft loss due to hepatitis C virus (HCV) recurrence is a serious problem after LT. The former conventional treatment with pegylated interferon and ribavirin is unsatisfying, due to poor response rates and tolerability. With the first interferon-free regimens that are currently being approved for the treatment of patients with chronic HCV, 2014 marks the beginning of a new era of treatment options for HCV recurrence after LT. This review summarizes the current experience with and the expectations of the new direct-acting antiviral agents in the setting of LT.