Recurrent hepatitis C virus infection post liver transplantation: impact of choice of calcineurin inhibitor

Authors


  • C. Duvoux has received research grants from Astellas, Roche and Novartis and has also been a speaker for Astellas, Roche and Novartis. R. Firpi has received research grants from Novartis, Vertex, Pharmasset, Bayer, BMS, Gilead, GSK, HGS, and Merck, and has received honoraria for participation in advisory boards from Vertex and Genentech. G. L. Grazi has participated in advisory boards for Novartis and received travel and/or research grants from Novartis and Astellas. G. Levy has participated in advisory boards for Novartis and has been a consultant for Astellas, Roche and Abbott Labs. E. Renner has provided consultation for Astellas, Novartis, Roche, and Vertex, has been a speaker for Novartis, is a member of the Scientific Committee for the SUSTAIN trial (Novartis) and has received unrestricted research grants from Novartis and Roche. F. Villamil has participated in Novartis advisory boards for the SUSTAIN and REVERT trials, and received travel and/or research grants from Novartis, Astellas, Janssen, Roche Argentina, and Gador.

Correspondence

Dr. Christophe Duvoux, Service d'Hépatologie, Hôpital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94 000 Créteil, France.

Tel.: +33 1 49 81 23 53;

fax: +33 1 49 81 23 52;

e-mail: christophe.duvoux@hmn.ap-hop-paris.fr

Summary

Recurrence of hepatitis C virus infection following liver transplantation (LT) for hepatitis C is universal. After LT, hepatitis C is associated with accelerated fibrosis progression and reduced graft and patient survival. Furthermore, responses to antiviral therapy in patients with recurrent hepatitis C virus post-transplant are consistently sub-optimal. Calcineurin inhibitors (CNIs) like cyclosporine A (CsA) and tacrolimus continue to dominate immunosuppressive regimens in this population; however, there is still uncertainty as to whether either offers an advantage in terms of patient outcomes. Although tacrolimus demonstrates improved efficacy in the general LT population, differences have begun to emerge between these agents regarding diabetogenic potential, antiviral activity, and fibrosis progression in patients with hepatitis C. This review critically evaluates the existing literature, providing an overview of the reported differences, concluding that despite conflicting evidence, a potential benefit of CsA in patients with hepatitis C is supported by the data and warrants further investigation. Future studies examining the role of CNIs in hepatitis C virus-positive LT recipients are required to accurately examine the effects of CNIs on outcomes such as fibrosis progression, survival, and effects on response to antiviral therapy, to provide robust information that allows clinicians to make an informed choice concerning which CNI is best for their patients.

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