years or decades chronic hepatitis
C virus (HCV) infection can progress to advanced liver disease
cancer and decompensated cirrhosis.
is the only option for end-stage liver failure, but HCV almost
always infects the new donor liver soon thereafter and is a
leading cause of graft and patient death.
Guillouche and C. Feray undertook a systematic review of research
on treatment of hepatitis C before and after liver transplantation.
They conducted a literature search for medical journals reports
and national conference abstracts published between 1990 and
2010. They gave extra weight to randomized clinical trials,
considered the "gold standard" of medical research.
Standard chronic hepatitis C therapy using pegylated
interferon (Pegasys or PegIntron) plus ribavirin "must
be considered before liver transplantation," the review
authors wrote, since studies have shown that it reduces the
risk of post-transplant HCV recurrence and disease progression.
But studies show that treatment is "poorly tolerated"
in general -- and even more so in people with advanced disease
-- and produces poor results in patients with end-stage or hepatocellular
Clinicians have explored interferon-based therapy starting soon
after liver transplantation in an attempt to prevent infection
of the new graft, but have had only limited success. Unlike
hepatitis B, administering anti-HCV antibodies does not reliably
prevent recurrent infection.
Pegylated interferon plus ribavirin produces sustained virological
response -- or continued undetectable HCV viral load 6 months
after completing treatment -- in up to one-third of patients
who experience HCV recurrence.
Based on these findings, the study authors concluded, "Currently
available anti-viral therapy is effective only in a minority
of transplanted patients infected with HCV."
New classes of directly-targeted antiviral drugs such as HCV
protease and polymerase inhibitors -- the first of which are
expected to be approved later this year -- may lead to better
outcomes for this hard-to-treat population.
Investigator affiliation: Institut des Maladies de l'Appareil
Digestif, Hôtel-Dieu, Nantes, France.
P Guillouche and C Feray. Systematic review: anti-viral therapy
of recurrent hepatitis C after liver transplantation. Alimentary
Pharmacology and Therapeutics 33(2):163-174 (Abstract).