treatment of hepatitis c infection with direct-acting antiviral agents in liver-transplant patients: a systematic review and meta-analysis

Context: recurrence of hepatitis c virus (hcv) infection after liver transplantation (lt) can be prevented, using antiviral therapy and new treatment regimens. combination of protease, ns5a, and ns5b inhibitors, with or without pegylated-interferon and ribavirin (peg-ifn/rbv), results in significantly high rates of sustained virologic response (svr) among post-lt patients with hcv infection. in this study, we aimed to assess the efficacy of direct-acting antiviral (daa) regimens in post-lt patients with hcv infection. evidence acquisition:we conducted a systematic search in electronic databases to detect eligible studies on daa treatments after lt.we evaluated english-language studies, including clinical trials and cohort studies, which used antiviral daa regimens (with or without peg-ifn/rbv) and reported svr rates at 12 weeks after the end of treatment (svr12). after data extraction, the pooled svrs were calculated, using stata version 11. results: a total of 35 studies with various hcv genotypes were included in our analysis. due to the small sample size and lack of suitable data on hcv genotypes 2 - 6, the meta-analysis was only conducted among patients with hcv genotype 1; the results of other studies were also obtained. svr12 rates ranged from 91% to 97% in patients with 12- or 24-week sofosbuvir (sof)/simeprevir (smv)rbv, sof/ledipasvir (ldv)rbv, and sof/daclatasvir (dcv)rbv regimens. theminimumsvr12 rate was found in patients receiving smv plus peg-ifn/rbv (59%; 95% confidence interval, 49 - 68). conclusions: administration of new hcv daa regimens can prevent post-lt hcv infection. the combination of sof/dcv and sof/ldv, with or without rbv, for 12 or 24 weeks can produce high rates of svr12 in post-lt hcv patients in different settings.