Journal
JOURNAL OF HEPATOLOGY
Volume 61, Issue -, Pages S120-S131Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.jhep.2014.07.020
Keywords
Decompensated cirrhosis; Waiting list; Liver transplantation; HCV recurrence; DAA; Sustained virologic response; Adverse events; Fibrosis regression
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Funding
- Instituto de Salud Carlos III [PI11/01907]
- Ministerio de Economia y Competitividad
- Fondo Europeo de Desarrollo Regional
- Union Europea
- Una manera de hacer Europa
- Roche Organ Transplantation Research Foundation (ROTRF) [CI: 442035057]
- EASL Entry Level Research Fellowship
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Interferon-based treatments have a poor safety profile and limited efficacy in patients with advanced liver disease and in patients with hepatitis C (HCV) recurrence after liver transplantation (LT). Despite the recent approval of the first interferon-free regimen, which will be followed by several other interferon-free combinations in 2014 and 2015, data in patients with advanced cirrhosis and hepatitis C after LT are still limited. One study has already proven the concept that graft HCV infection can be prevented in a significant proportion of patients by treating them with sofosbuvir and ribavirin while awaiting LT. Two interferon-free regimens have also demonstrated a high efficacy in patients with hepatitis C recurrence after transplantation. Before these treatment strategies can be implemented in clinical practice, a few issues need to be addressed: (1) safety and efficacy of new antivirals in patients with decompensated cirrhosis, (2) the impact of viral clearance on liver function, (3) the potential consequences of virological failure (and the selection of multidrug resistant HCV strains) in patients with decompensated cirrhosis or with severe hepatitis C recurrence after LT, and (4) drug-drug interactions (DDI) profiles. Finally, in the transplant setting it is also relevant to learn which strategy is most cost-effective in minimizing the negative impact of hepatitis C: preventing graft infection by treating patients before transplantation or treating hepatitis C recurrence after LT. (C) 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
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