Prophylactic and preemptive therapies for hepatitis C virus-infected patients undergoing liver transplantation.

1. Preclinical data from chimpanzees and studies in hepatitis B virus/hepatitis C virus (HCV) coinfected transplant recipients suggest prophylactic HCV antibody therapy may have a role in the prevention of HCV recurrence. 2. There are insufficient data available to evaluate the efficacy of this therapeutic approach. A small study found no benefit. Other ongoing studies using alternative antibody preparations and more intensive dosing schedules are underway. 3. Preemptive antiviral therapy, started within the first 4 weeks posttransplantation and prior to the onset of clinical signs and symptoms, is effective in some patients (5-33%) and is not associated with an increased risk of acute rejection. Tolerability of antiviral agents in the early posttransplantation period may be a factor limiting treatment efficacy. 4. It is unclear whether the preemptive antiviral treatment is superior to delaying treatment until recurrent disease is present and controlled trials addressing this issue are needed.