Recurrent HCV after liver transplantation—mechanisms, assessment and therapy

HCV recurrence occurs in all patients with a detectable HCV viral load at the time of liver transplantation and results in increased morbidity and decreased graft survival compared with other patient groupsFibrosis progression is accelerated after a liver transplant, which results in graft cirrhosis in up to 30% of patients within 5 yearsFibrosis should be assessed at 12 months after transplantation to identify patients with rapid fibrosis progression; transient elastography is a sensitive noninvasive tool to assess fibrosis in these patientsCurrent antiviral therapy utilizes a PEG-IFN component, which limits the number of patients who can be treated and decreases tolerability, with disappointing sustained virologic response ratesNew combinations of different classes of direct-acting antiviral agents (DAAs) will obviate the requirement for PEG-IFN and will probably have a considerable effect on therapy before and after liver transplantationPreliminary data suggest that DAAs will decrease the recurrence of HCV infection and provide notable improvements in patient and graft outcomes