Facing HCV recurrence after liver transplantation: antiviral therapy response and clinical outcome

End-stage liver disease related to HCV infection is the most common indication for liver transplantation both in Europe and in USA (http://www.UNOS.org; http://www.ELTR.org). The results of liver transplantation for this indication are negatively affected by the high rate of viral recurrence which, through an accelerated rate of disease progression, significantly impairs patient and graft survival.

Given this scenario, post-transplant viral eradication should be identified as a primary goal. At present, a combined regimen with pegylated interferon and ribavirin leads to sustained virological response (SVR) in approximately 30% of transplanted patients, which is significantly lower than in immunocompetent subjects. The main problem lies in the high rate of side effects which leads a significant proportion of patients to not receive appropriate therapy. Moreover, in view of the immunological activity of interferon, transplanted patients are exposed to additional immunological risks. Thus, role and efficacy of antiviral therapy in HCV recurrent hepatitis is still under debate. Nevertheless, a progressive amount of data from field practice are now demonstrating that SVR after post-transplant antiviral treatment is associated with a significant benefit on patient and graft survival and is the most relevant modifier of the natural history of HCV recurrent disease after liver transplantation.