New Insights in Recurrent HCV Infection after Liver Transplantation

Hsu, Shih-Hsien; Yeh, Ming-Lun; Wang, Shen-Nien

Because of the accelerated clinical course of recurrent hepatitis C after LT, strategy to prevent reinfection of the graft is needed. Antihepatitis B immunoglobulin had been approved to successfully prevent HBV recurrence after LT. It is used in antibody therapy for HCV-infected recipients. However, recent studies using hepatitis C immunoglobulin or monoclonal antibody show only transient decrease of liver HCV RNA levels in liver transplant recipients [62, 63] . Preemptive or early posttransplant antiviral therapy aims to prevent the rapid development of chronic hepatitis before there is evidence of recurrent HCV infection. It is usually initiated within one month after LT. Compared to immunocompetent subjects, antiviral therapy response decreases during this period because of the high level of immunosuppression. A pilot study by Mazzaferro collected 36 HCV-RNA + cirrhotic patients who started a 12-month IFN plus RBV combination therapy within 3 weeks after LT [64] . The sustained virological response (SVR) was achieved in 33% of patients. None of the patients developed graft rejection, and normal histology was also noted in patients with SVR after a median followup of 52 months. However, higher than 26% of graft rejection was noted in another study using IFN and RBV combination therapy for more than 12 months [65] . Moreover, four other studies using different regiments, two IFN monotherapy and two pegylated-IFN monotherapy, showed a poor effect of less than 20% of SVR and a higher rate of treatment discontinuation and graft rejection [66] [67] [68] [69] . Therefore, more prospective and large-scaled studies are still needed to investigate the most appropriate regimen for Preemptive treatment.