Pre- and Post-Transplant Treatment of Viral Hepatitis C

Hepatitis C (HCV) is a common cause of liver failure and liver cancer, and is a frequent indication for liver transplantation (LT). Until recently, a majority of transplanted patients were viraemic at the time of transplantation and they inevitably underwent recurrent infection of the graft. Prior to the availability of specific direct-acting antiviral (DAA) drugs, HCV infection was seldom successfully treated before or after transplantation. Key Messages: During the past 2 years, the use of interferon-free DAA therapy has transformed the management of patients post-LT and of patients on the transplant waiting list. DAA treatment post-LT can eradicate infection and normalize liver function tests in a majority of treated patients. An improvement in long-term graft and patient outcome can be anticipated. DAA treatment of patients with liver failure awaiting LT eliminates infection and is associated with an improvement in the liver function for a majority of treated patients. The majority still require transplantation, though some may improve sufficiently and quickly enough to be removed from the LT waiting list.

Eventually, as greater numbers of patients with compensated cirrhosis are successfully treated with DAAs, HCV-associated liver failure may become an uncommon indication for LT.