{'fraction_non_alphanumeric': 0.02303070761014686, 'fraction_numerical': 0.008678237650200267, 'mean_word_length': 5.2698744769874475, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Is early antiviral therapy for recurrent hepatitis C after liver transplantation superior to later treatment? The answer is no

Liver disease due to hepatitis C virus (HCV) is the main cause of cirrhosis and hepatocellular carcinoma and is the leading indication for liver transplantation (LT) in Western countries. Unfortunately, reinfection with HCV after LT is universal in patients who are HCV RNA– positive according to polymerase chain reaction at the time of LT, and the course of HCV-induced disease in liver allografts is more rapid than the course of HCVinduced disease in immunologically competent patients. After LT for HCV-related disease, the incidence of chronic infection with HCV is 75% to 90%, and 5% to 30% of patients develop cirrhosis within 5 years. Because of the impact of recurrent HCV infection on graft and patient survival, several treatment strategies for preventing or more effectively treating HCV infection have been evaluated: antiviral treatment before LT, prophylactic therapy, preemptive therapy initiated soon after LT, and therapy for established chronic hepatitis C after LT. Prophylactic therapy is typically started during the anhepatic phase to prevent the reinfection of graft with HCV. In this context, the administration of hepatitis C immune globulin has been disappointing; this approach has been associated with only transient decreases in hepatic HCV RNA and serum aminotransferase levels. Preemptive antiviral therapy should be initiated early after LT, preferably during the first month when the viral load tends to be at its lowest level and hepatic fibrosis is usually absent. In patients with chronic hepatitis C unrelated to LT, a low pretreatment viral load, a mild stage of hepatic fibrosis, and low hepatitis activity are predictors of a high rate of viral clearance. These findings provide a rationale for preemptive therapy. However, such patients differ from those with recurrent HCV infection after LT. Patients with HCV-induced disease who have undergone LT are chronic carriers of HCV, and their response to antiviral therapy may be adversely affected by immunosuppressive therapy. Potential benefits of preemptive therapy include the attenuation of histological indices of disease activity and the retardation of fibrosis progression. The main drawbacks of this therapy are its low applicability and the appreciable risks of poor hematological tolerance, rejection, and sepsis. In a study by Shergill et al., patients who were ineligible for antiviral therapy had significantly higher Model for End-Stage Liver Disease scores before LT. The high prevalence of renal dysfunction and anemia in patients infected with HCV post-LT makes the administration of ribavirin (RBV) difficult in this population. In published studies of preemptive antiviral therapy, sustained virological response (SVR) rates have varied from 8% to 39% (median 1⁄4 16%): 5% to 33% for patients with genotype 1 (G1) and 14% to 100% for patients with genotype 2