New approaches and therapeutic modalities for the prevention and treatment of recurrent HCV after liver transplantation

1. The currently available interferon-based therapeutic regimens are not optimal for the treatment of recurrent hepatitis C after liver transplantation. 2. Many patients have contraindications to use of the drugs, dose reductions limit exposure to effective doses in most patients, and the therapy is labor intensive for the transplantation staff. 3. Better strategies are needed to control hepatitis C virus infection in the transplantation setting. Aggressive treatment of infected patients before they develop cirrhosis or hepatic decompensation may eliminate the need for transplantation in some and reduce the chance for posttransplantation recurrence in others. 4. Infusions of neutralizing antibodies or short courses of therapy with potent antiviral drugs in the peritransplantation period may reduce the chance of infection of the graft. 5. New antiviral strategies, including use of oligonucleotides and viral enzyme inhibitors, may prove useful in the future, but these agents are just beginning to be tested in clinical trials in human beings.