Interferon-free antiviral therapy for chronic hepatitis C among patients in the liver transplant setting

Area of Science:

• Hepatology
• Virology
• Transplantation Medicine

Background:

• Chronic hepatitis C (HCV) remains a significant global health issue.
• Direct-acting antivirals (DAAs) have revolutionized HCV treatment, offering a cure.
• DAAs can improve liver function in patients awaiting transplantation.

Purpose of the Study:

• To discuss the optimal timing of direct-acting antiviral (DAA) therapy in patients with chronic hepatitis C (HCV).
• To evaluate the long-term benefits of DAAs initiated before or after liver transplantation.
• To address the emerging use of HCV-positive organ donors in the context of effective DAA therapy.

Main Methods:

• Review of current literature on DAA efficacy and outcomes in HCV patients.
• Analysis of clinical scenarios for DAA treatment in pre- and post-liver transplant settings.
• Discussion of ethical and logistical considerations for using HCV-positive donors.

Main Results:

• DAA therapy is highly effective in curing HCV, including in advanced liver disease.
• Early DAA treatment may improve liver function and potentially prevent the need for liver transplantation.
• DAA treatment is also effective post-transplantation, raising questions about treatment sequencing.

Conclusions:

• The optimal timing for initiating DAA therapy in chronic HCV patients, particularly those with advanced liver disease, requires careful consideration.
• The potential benefits of pre-transplant DAA treatment must be weighed against the effectiveness of post-transplant therapy.
• The use of HCV-positive donors for transplantation is becoming more feasible due to effective DAA eradication therapies.