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Direct Antiviral Agents for the Treatment of Hcv Reinfection after Liver Transplantation

Annagiulia Gramenzi, Marco Dall’agata, Maurizio Biselli and Mauro Bernardi

Recurrence of hepatitis C virus (HCV) infection after liver transplantation (LT) is almost universal and leads to cirrhosis in up to 30% of patients by five years. Considering the increasing shortage of donor organs and the accelerated progression of HCV in transplant recipients, the development of effective strategies to treat or prevent HCV recurrence are of paramount importance. Therapy with pegylated–interferon plus ribavirin, although less efficacious than in immunocompetent patients, is currently the treatment of choice of LT recipients with histologically proven recurrence of hepatitis C. However, this combination therapy results in a sustained virological response in around 30-45% of patients and is poorly tolerated. The new classes of potent and direct-acting antiviral agents (DAAs) will certainly improve the results of pre- and post-transplant antiviral therapy. The aim of this review is to identify and summarize the experience with the use of direct-acting antivirals in LT HCV patients. PubMed, the Cochrane Library, MEDLINE, EMBASE and Web of Science databases were searched for this purpose. To date, there are no published clinical studies on this topic and the only available data are in abstract form. The heterogeneous study designs and populations, the small number of enrolled patients, the different treatment schedules and follow-up periods and the ongoing nature of the reports make the results largely inconclusive or even anecdotal. In conclusion, the use of DAAs in HCV liver transplanted patients cannot be recommended until well designed large clinical studies will be performed.