Effect of ezetimibe in HCV viral load after liver transplantation.

Chronic hepatitis C virus (HCV) infection is the leading reason for liver transplantation in Western countries.1 Unfortunately, reinfection of the graft is universal after transplantation,2 occurring early at reperfusion.3 There is no accepted approach for preventing reinfection, but strategies aimed at blocking viral entry to the hepatocyte seem interesting in this clinical scenario. HCV circulates in human serum associated with various lipoproteins, including HDL, LDL and VLDL, forming lipo-viral particles (LVP),4-6 and among the various entry factors described, several are related to lipoprotein receptors, including LDL receptor7 and scavenger receptor class B type I (SCARB1, also known as SR-BI).8 In 2012 a new entry factor was described: Niemann-Pick C1-like 1 (NPC1L1).9 NPC1L1 is a cholesterol-sensing receptor expressed in enterocytes and in the liver in humans, which can be antagonized by ezetimibe. We were interested in knowing if using ezetimibe for HCV infected patients undergoing a liver transplantation could avoid or delay viral infection of the graft. For this purpose, a pilot clinical trial was designed to enroll 12 patients with no control arm (given that reinfection is universal). Briefly, patients in the waiting list for a liver transplantation with chronic hepatitis C were invited to participate in this study. The inclusion criteria were: