Open AccessTreatment strategies for chronic hepatitis C prior to and following liver transplantation
Author(s) -
Ryan B. Perumpail,
Thomas A. Hahambis,
Avin Aggarwal,
Zobair M. Younossi,
Aijaz Ahmed
Publication year - 2016
Publication title -
world journal of hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.913
H-Index - 55
ISSN - 1948-5182
DOI - 10.4254/wjh.v8.i1.69
Subject(s) - medicine , tolerability , liver transplantation , hepatitis c virus , hepatitis c , liver disease , antiviral therapy , chronic liver disease , immunology , interferon , transplantation , intensive care medicine , gastroenterology , chronic hepatitis , adverse effect , virus , cirrhosis
Hepatitis C virus (HCV)-related liver disease is the leading indication for liver transplantation (LT) worldwide. However, HCV is an independent predictor of lower survival following LT, and recurrence of HCV post-LT is virtually universal. The historic standard of care during the interferon era of HCV therapy was expectant management-initiation of antiviral therapy in the setting of documented disease progression following LT. With the advent of new direct acting antiviral (DAA) therapies for HCV, the paradigm of expectant treatment for recurrent HCV infection post-LT is shifting. The safety, tolerability, and efficacy of DAAs, even among the sickest patients with advanced liver disease, enables treatment of HCV in the pre-transplant setting among LT waitlist registrants. Finally, emerging data are supportive of preemptive therapy with DAAs in liver transplant recipients as the preferred approach. Expectant management of HCV following LT can rarely be justified in the modern era of HCV therapy.