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A pleasant dilemma to have: to treat the HCV patient on the waiting list or to treat post‐liver transplantation?
Author(s) -
Barsa Jonathan E.,
Branch Andrea D.,
Schiano Thomas D.
Publication year - 2015
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12596
Subject(s) - medicine , liver transplantation , waiting list , dilemma , transplantation , surgery , intensive care medicine , hepatitis c , immunology , philosophy , epistemology
Abstract New and relatively well‐tolerated medications to treat hepatitis C virus ( HCV ) infection have presented an opportunity for hepatologists to eliminate HCV in liver transplant ( LT ) candidates prior to transplantation. While concern for causing decompensated liver disease in the sickest subset of pre‐transplant patients makes some clinicians reluctant to offer treatment, we believe that several advantages of early HCV eradication appear to shift the debate in favor of using anti‐ HCV agents before LT . There are encouraging safety data for new HCV medications in cirrhotic patients, and given the limited supply of donor livers available, delaying or possibly preventing the need for LT by treating HCV can offer significant benefit. Post‐ LT , making immunosuppression management easier as well as avoiding both extrahepatic manifestations of HCV (e.g., diabetes mellitus and kidney disease) and the dilemma of distinguishing post‐transplant viral recurrence from allograft rejection makes earlier treatment of HCV especially appealing to clinicians. Furthermore, retrospective data have demonstrated a mortality benefit among HCV patients who are free of the virus at the time of LT . This article explores arguments for and against treating HCV in patients on the transplant list.