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Reduced Complications after Arterial Reconnection in a Rat Model of Orthotopic Liver Transplantation
Published on: November 7, 2020
Hepatitis C and liver transplantation
1Unit of Gastrohepatology, AOU Città della Salute e della Scienza di Torino, Turin, Italy - smartini@cittadellasalute.to.it.
Insights
Direct-acting antiviral agents (DAAs) offer curative treatment for Hepatitis C virus (HCV) infection, impacting liver transplantation (LT) decisions. Optimal timing for DAA treatment in LT candidates and recipients remains under investigation.
Area of Science:
- Hepatology and Transplant Surgery
- Virology and Infectious Diseases
- Pharmacology and Therapeutics
Background:
- Hepatitis C virus (HCV) infection is a primary driver for liver transplantation (LT) in the USA and Europe.
- HCV recurrence post-LT is nearly universal in viremic recipients.
- Previous treatments like pegylated-interferon and ribavirin had limited efficacy and applicability.
Purpose of the Study:
- To review the impact of direct-acting antiviral agents (DAAs) on HCV management in liver transplantation.
- To discuss optimal timing for DAA treatment initiation in relation to LT (pre-LT, early post-LT, or post-recurrence).
- To explore the potential of using HCV-positive donors to expand the donor pool.
Main Methods:
- Review of published data on DAA efficacy and safety in liver transplant recipients and candidates.
- Analysis of trends in LT wait-listing for HCV-related liver disease.
- Discussion of clinical considerations for DAA treatment strategies.
Main Results:
- DAAs have significantly improved curative treatment options for HCV in the transplant population.
- The use of HCV-positive donors is a potential strategy to increase donor availability.
- LT wait-listing for HCV with decompensated cirrhosis decreased by 32% in the US during 2014-2015 DAA era.
Conclusions:
- DAA treatment is highly applicable to patients with decompensated cirrhosis and liver transplant recipients.
- The advent of DAAs is shifting the landscape of HCV management, potentially reducing LT rates.
- Further research is needed to determine the optimal timing for DAA therapy in the LT pathway.
Abstract:
Hepatitis C virus (HCV)-related liver disease represents the leading indication for liver transplantation (LT) in the USA and Europe and HCV recurrence is universal in recipients who are viremic at LT. Until a few years ago, pegylated-interferon in association with ribavirin was the only therapeutic strategy, usable only in compensated cirrhotic patients, in order to prevent post-LT viral recurrence. The recent advent of direct-acting antiviral agents (DAAs) has dramatically increased the chances of curative treatment for the transplant population and the debate about which should be the best time for treating the infection is still open: whether to pursue HCV eradication 1) before LT, in order to improve liver function, delist some patients and prevent graft infection; or 2) as early as possible after LT, rather than 3) waiting for hepatitis C recurrence before starting treatment. In addition, in the DAA era, the use of HCV-positive donors may represent a potential approach to safely expanding the donor pool. As more HCV patients achieve cure with DAA regimens, the LT trend for HCV in the future would be expected to mimic the trend observed for hepatitis B virus in the past decade and in the United States, during the DAA-period 2014-2015, the rate of LT wait-listing for HCV complicated by decompensated cirrhosis has already decreased by 32%. This review summarizes the published data and emphasizes DAA treatment applicability to patients with decompensated cirrhosis and to liver transplant recipients.
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