The Profilaxis and Treatment of C Virus Liver Disease in the Liver Transplantation Setting. Narrative Review

Abstract Objective To review the use of antiviral therapy as prophylaxis or treatment of virus C liver disease in the liver transplantation setting. Method A search was made of the literature in PubMed with the strategy “ liver transplantation ” AND “ hepatitis C, ” AND (“ interferon ” OR “ peginterferon, ” OR “ ribavirin ”) from 1966 to June 2007 and a manual search of the journals Gastroenterologia y Hepatologia, Journal of Hepatology and Hepatology between 2001 and June 2007, to identify publications and communications to congresses relating to the subject. The studies identified were selected and evaluated. Results A total of 48 articles were chosen for review. Hepatitis C virus is one of the main indications for liver transplantation. Post-transplant re-infection is immediate and almost universal, and results, in many cases, in a recurrent liver disease that reduces the patient's survival. Four basic therapeutic strategies have been studied: pre-transplant anti-viral treatment, prophylaxis, early or preventative treatment, and treatment of acute or chronic recurrent hepatitis C. Conclusions Currently, the hepatitis C treatment in the liver transplantation setting is based on the use of peginterferon associated with ribavirin as pre-transplant treatment in selected patients or as treatment of recurrent post-transplant hepatitis C, achieving sustained virological responses of around 20% and 35% respectively. The main limitation of these treatments is the high frequency of the adverse effects and interruptions to treatment, meaning it is important to carry out strict follow-up of the treatment safety.