Centre Hépatobiliaire, Unité INSERM U 785, Université Paris-Sud, Hôpital Paul Brousse, 14 avenue Paul Vaillant-Couturier, 94800 Villejuif, France
Liver disease caused by the hepatitis C virus is the main indication for liver transplantation. However, HCV re-infection after transplantation is constant and it significantly impairs patient and graft survival. Pretransplant antiviral therapy may reduce or eliminate the risk of recurrent infection. However, this approach is limited because of side effects and a risk of complications in decompensated patients. The best candidates for therapy are Child-Pugh class A patients and patients with good predictive factors of response (non-1 genotype and low viral load). Multiple host, donor and viral factors are associated with fibrosis progression after transplantation. Treatment of established graft lesions with pegylated interferon and ribavirin combination therapy gave promising results, with sustained virological response in around 30% of patients. Sustained virologic responders had a long-term benefic effect on fibrosis progression and graft and patient survival. Variables associated with SVR are non-1 genotype, absence of prior antiviral therapy, early virologic response, adherence to therapy and low pre-treatment viral load. HCV-infected pre-and post-transplant patients are the population which will benefit the most of new classes of direct antiviral agents.