Considerations When Treating Hepatitis C in a Cirrhotic Transplant Candidate

• Published in: Current gastroenterology reports Vol. 20; no. 5; p. 20
• Main Authors: Daniel, Kimberly E., Said, Adnan
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.05.2018; Springer Nature B.V
• Subjects: Candidates; Cohort analysis; Drug interactions; Gastroenterology; Hepatitis C; Infections; Liver (S Cotler and E Kallwitz; Liver cancer; Liver cirrhosis; Liver diseases; Liver transplants; Medical prognosis; Medicine; Medicine & Public Health; Mortality; Narcotics; Patients; Quality of life; Section Editors; Topical Collection on Liver; United States > US; Cirrhosis; Liver decompensation; Direct-acting antivirals (DAA); Hepatocellular carcinoma (HCC); Hepatitis C (HCV); Liver transplant; Delisting
• ISSN: 1522-8037; 1534-312X
• DOI: 10.1007/s11894-018-0626-9

Purpose of Review This review examines the issues in determining the decision to treat a HCV-positive patient who is a liver transplant (LT) candidate with highly effective and well-tolerated direct-acting antiviral (DAA) therapies. Recent Findings Cure of HCV with DAA can improve liver function and allow delisting in some patients. Beyond a threshold of hepatic impairment (likely MELD score > 16 to 20), patients may experience a decline in MELD score with HCV cure without improvement in liver-related complications resulting in decreased opportunity to receive a LT. Eradicating HCV from patients who need LT regardless also deprives them of the option of receiving HCV-positive donor organs. Patients with MELD > 16 or Child-Pugh B/C may also have reduced cure rates of HCV, increased risk of hepatic decompensation, and adverse events with DAA pre-LT compared to post-LT DAA therapy. Preliminary data demonstrates increase risk of hepatocellular carcinoma (HCC) recurrence after treatment with DAA with subsequent studies raising doubts about this association. Summary Patients with HCV cirrhosis on the LT waiting list with MELD score > 16, CTP-B/C, and HCC are best treated after LT with better response, tolerability, and the ability to receive organs from a larger donor pool that includes HCV-positive donors. Larger, prospective studies are needed to assess whether increased HCC recurrence after DAA is a true effect.