| [ Summary ] |
Recurrence of hepatitis C after liver transplantation is a major problem ; it is characterized by rapid progression of the disease, cholestatic hepatitis, and coexistence of other liver complications, such as rejection and biliary complications. In the treatment of HCV infection, peginterferon and ribavirin have been administered in the past, to prevent progression of hepatitis C after liver transplantation. However, this treatment has low efficacy and causes many adverse events, including immune‒mediated graft dysfunction. Interferon‒containing regimens with direct‒acting antivirals (DAAs) improve treatment efficacy, but DAAs cause serious adverse events and may lead to drug‒drug interactions. Recent studies have demonstrated the efficacy and safety of interferon‒free therapy with DAAs before and after liver transplantation, which has ushered in a new era of treatment strategies for treating HCV in transplant recipients. Interferon‒free therapies are safe and effective in patients before and after liver transplantation, as well as in those with fibrosing cholestatic hepatitis C. However, several obstacles must be overcome before the widespread adoption of interferon‒free therapy, such as overcoming drug‒drug interactions, developing a treatment strategy for treating decompensated cirrhosis, and treating renal failure. These problems are expected to be solved in the near future, and the poor prognosis of HCV‒positive recipients is likely to improve soon. |