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

Abstract

BACKGROUND:

Hepatitis C virus (HCV) 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, sustained virological response. An emphasis was placed on randomised trials.

RESULTS:

Anti-viral 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 or hepatocellular carcinoma. Anti-viral therapy can be administrated systematically early after liver transplantation, or in patients with established recurrent chronic hepatitis. Combination of pegylated interferon alpha plus ribavirin results in a sustained virological response of up to 30% in patients with histological HCV recurrence. The results of a small trial of polyclonal anti-HCV to prevent recurrence were disappointing.

CONCLUSIONS:

Currently available anti-viral therapy is effective only in a minority of transplanted patients infected with HCV. Specifically targeted anti-viral therapies combining interferon alpha and ribavirin, or a combination of antiprotease and antipolymerase components, associated with a genetic prediction of anti-viral response and blocking HCV cell entry should improve the long-term prognosis of recurrent hepatitis C in the near future.

• Authors: P Guillouche, C Féray
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 33 Issue 2 Pg. 163-74 (Jan 2011) ISSN: 1365-2036 [Electronic] England
• PMID: 21083593 (Publication Type: Journal Article, Review, Systematic Review)
• Copyright: © 2010 Blackwell Publishing Ltd.

Chemical References

• Antiviral Agents
• Ribavirin
• Interferons

Topics

• Antiviral Agents (therapeutic use)
• Drug Therapy, Combination
• Hepacivirus (drug effects)
• Hepatitis C, Chronic (drug therapy)
• Humans
• Interferons (therapeutic use)
• Liver Transplantation (adverse effects)
• Randomized Controlled Trials as Topic
• Ribavirin (therapeutic use)
• Treatment Outcome