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

Authors
  • Cholankeril, George1
  • Joseph-Talreja, Mairin1
  • Perumpail, Brandon J2
  • Liu, Andy3
  • Yoo, Eric R4
  • Ahmed, Aijaz1
  • Goel, Aparna1
  • 1 Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
  • 2 Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
  • 3 Department of Medicine, California Pacific Medical Center, San Francisco, CA, USA.
  • 4 Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA.
Type
Published Article
Journal
Journal of clinical and translational hepatology
Publication Date
Dec 28, 2017
Volume
5
Issue
4
Pages
363–367
Identifiers
DOI: 10.14218/JCTH.2017.00007
PMID: 29226102
Source
Medline
Keywords
License
Unknown

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.

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