Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Monday, 12 / 10 / 2018

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Timing of Hepatitis C Virus Treatment in Liver Transplant Candidates in the Era of Direct-acting Antiviral Agents

REVIEW ARTICLE

Timing of Hepatitis C Virus Treatment in Liver Transplant Candidates in the Era of Direct-acting Antiviral Agents

George Cholankeril1, Mairin Joseph-Talreja1, Brandon J. Perumpail2, Andy Liu3, Eric R. Yoo4, Aijaz Ahmed*,1 and Aparna Goel1

1Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
2Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
3Department of Medicine, California Pacific Medical Center, San Francisco, CA, USA
4Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA

*Correspondence to: Aijaz Ahmed, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road, Suite #210, Stanford, CA 94304, USA. Tel: +1-650-498-6091, Fax: +1-650-498-5692, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2017;5(4):363-367 DOI: 10.14218/JCTH.2017.00007

Received: January 19, 2017 Accepted: August 18, 2017 Published online: September 14, 2017

Abstract

Chronic hepatitis C virus (HCV) infection remains the leading indication for liver transplantation (LT) in the United States. While most patients with chronic HCV infection remain asymptomatic, up to one-third develop progressive liver disease resulting in cirrhosis. LT is often the only curative treatment once significant hepatic decompensation develops. However, antiviral therapy for HCV infection has advanced markedly in the past 5 years with the discovery and approval of direct-acting antiviral agents. These new regimens are well tolerated, of short duration and highly effective, unlike the traditional treatment with pegylated-interferon and ribavirin. As achieving sustained virological response becomes increasingly attainable for a majority of HCV-infected patients, concerns have been raised regarding the optimal timing of treatment for HCV infection in the setting of end-stage liver disease and during the peri-transplant period. On one hand, HCV treatment may improve hepatic function and negate the need for LT in some, which is crucial given the scarcity of donor organs and mortality on the waiting list in certain regions. On the other hand, HCV treatment may result in lowering the priority for LT without improving quality of life, thereby delaying potentially curative LT surgery. This review evaluates the evidence supporting the use of direct-acting antiviral agents in the period before and following LT.

Keywords

Hepatitis C virus, Direct-acting antiviral therapy, Liver transplantation

 

Journal of Clinical and Translational Hepatology 2017 vol. 5, 363-367 Html ] [ PDF Full-text ]

© The Authors 2017. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

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