Treatment of hepatitis C in patients with cirrhosis and pre- and post-liver transplantation

Background. In 2014, the first interferon-free regimens were approved for the treatment of patients with chronic hepatitis C virus (HCV). For patients with cirrhosis and in the liver transplant (LT) setting, these regimens are expected to have an important effect, because graft loss due to HCV recurrence is a serious problem after LT. Objective. To summarize the experience with the new direct-acting antiviral (DAA) agents for patients pre- and post-LT. Methods. Evidence from patient cohorts, compassionate use programs (CUP), and clinical trials for the use of the new DAAs in cirrhosis and pre- and post-LT was analyzed. Results. With the approval of sofosbuvir (SOF), simeprevir (SMV), daclatasvir (DCV), and ledipasvir (LDV), several all-oral antiviral combinations are now available which are applicable without relevant adverse effects or drug-drug interactions with immunosuppressants (IS). The combination of ritonavir-boosted paritaprevir/ombitasvir/dasabuvir (ABT450/r/O/D) supplemented the options at the beginning of 2015 but has slight limitations for application after LT due to interactions with IS. So far, data for patients with cirrhosis and LT patients are scarce for all regimens, while reports on smaller cohorts of several interferon-free regimens for patients with cirrhosis, pre-LT or HCV recurrence after LT have achieved good preliminary results and are very promising. Conclusion. Evaluations of current clinical trials, real-life experiences and evaluations from compassionate use programs are eagerly awaited for this year. So far, HCV reinfection after LT can not only be treated but can also be avoided in the meantime. Moreover, it can be expected that, considering current therapeutic options, HCV as the indication for LT will become even less common.