الفهرس 
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Abstract
Hepatitis C virus (HCV) infection is still the most common cause of chronic liver disease worldwide with 130-150 million patients being infected with 15%-30% of them develop cirrhosis and 3%-5% have annual risk of hepatocellular carcinoma. HCV is one of the most common indications for liver transplantation globally.
HCV allograft infection is inevitable after liver transplantation (LT) on a background HCV infection and cirrhosis will develop in up to 30% of patients within 5 years post transplantation. Due to faster cirrhosis progression in hepatic allograft, so the eradication of HCV infection in post-LT is a primary concern.
The treatment of HCV infection with SVR has many advantages of risk reduction of liver decompansation and hepatocellular carcinoma, improved survival and outcomes even in patients with severe hepatic disease.
The direct-acting antivirals (DAAs) are considered now the drug of choice for the treatment of HCV infection. Recently, almost all clinical guidelines recommend therapy of HCV RNA positive patients regardless underlying liver disease severity and levels of the serum alanine amino transferase. DAAs have better results in management of HCV infection with more than 95% sustained virological response (SVR) 12 weeks post treatment in non-cirrhotic candidates and in advanced and decompensated cirrhosis can reach 90%-95%.
Past treatment with interferon and ribavirin for recurrent liver graft infection with hepatitis C virus, despite its positive impact on survival, had several side effects such as low SVR (15-35%), a high discontinuation rate (up to 40%) and drug-drug interactions.
Although eradication of HCV infection before LT while on the waiting list is the most likely option to avoid reinfection of graft, there is still patients with HCV infection who have not been fit for therapy before LT or DAAs were not available before transplantation.
There are selected regimens of DAAs tested for treatment of HCV infection post LT. They showed cure rates of greater than 90% in most patients. However, there is restricted clinical information on how these regimens are safe and effective in LT patients.
Drug-drug interactions are major concern when treating HCV patients in the setting of immunosuppressive drugs after LT. as some DAAs need no dose adjustment with use of immunosuppressive agents; others pose critical interactions with immunosuppressive therapy.