Considerations When Treating Hepatitis C in a Cirrhotic Transplant Candidate

Liver (S Cotler and E Kallwitz, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Liver

Abstract

Purpose of Review

This review examines the issues in determining the decision to treat a HCV-positive patient who is a liver transplant (LT) candidate with highly effective and well-tolerated direct-acting antiviral (DAA) therapies.

Recent Findings

Cure of HCV with DAA can improve liver function and allow delisting in some patients. Beyond a threshold of hepatic impairment (likely MELD score > 16 to 20), patients may experience a decline in MELD score with HCV cure without improvement in liver-related complications resulting in decreased opportunity to receive a LT. Eradicating HCV from patients who need LT regardless also deprives them of the option of receiving HCV-positive donor organs. Patients with MELD > 16 or Child-Pugh B/C may also have reduced cure rates of HCV, increased risk of hepatic decompensation, and adverse events with DAA pre-LT compared to post-LT DAA therapy. Preliminary data demonstrates increase risk of hepatocellular carcinoma (HCC) recurrence after treatment with DAA with subsequent studies raising doubts about this association.

Summary

Patients with HCV cirrhosis on the LT waiting list with MELD score > 16, CTP-B/C, and HCC are best treated after LT with better response, tolerability, and the ability to receive organs from a larger donor pool that includes HCV-positive donors. Larger, prospective studies are needed to assess whether increased HCC recurrence after DAA is a true effect.

Keywords

Direct-acting antivirals (DAA) Hepatitis C (HCV) Liver transplant Cirrhosis Liver decompensation Hepatocellular carcinoma (HCC) Delisting 

Notes

Compliance with Ethical Standards

Conflict of Interest

Adnan Said and Kimberly Daniel declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Gastroenterology and Hepatology FellowMedical College of WisconsinMilwaukeeUSA
  2. 2.Gastroenterology and Hepatology, Department of MedicineUniversity of Wisconsin School of Medicine and Public Health and Madison VAMCMadisonUSA

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