Timing for treatment of HCV recurrence after liver transplantation: the earlier the better.

HCV is the leading cause of death from liver disease and is the most common indication for a liver transplantation. Although HCV is a widespread health problem, disease management is particularly challenging in several key subpopulations, including liver transplant recipients. HCV recurrence after liver transplantation constituted a major challenge for the physicians during the last years. The recommended standard of care before the advent of new regimen was the treatment of confirmed recurrent disease, based either on persistent, unexplained elevated alanine aminotransferase levels or on histologically confirmed fibrosis, once rejection, biliary obstruction, and vascular damage have been ruled out. Moreover, early therapy (including interferon) has been associated with high rates of adverse effects, an increased risk of graft rejection, and higher proportions of patients requiring dose reductions. We are now facing a "new era" of direct antiviral agents that is already changing the approach to HCV burden in the post liver transplantation setting. Available data on treatment of HCV recurrence with the new antiviral drugs showed sustained virological response that ranges between 60 to 100%. In this comment we have focused on both the utility of non invasive test to evaluate the fibrosis progression and on timing of antiviral therapy for HCV recurrence. This article is protected by copyright. All rights reserved.