Use of DAAs in the management of HCV in the liver transplantation setting

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Infectious Disease Advisor

Management of HCV in Liver Transplant Candidates and Recipients

Christina T. Loguidice

July 05, 2017

Infectious Disease Advisor had the opportunity to discuss the use of DAAs in the management of HCV in the liver transplantation setting with Leslie B. Lilly, MD, FRCPC, medical director, GI Transplantation, and assistant professor of medicine, Toronto General Hospital, Ontario, Canada. Dr Lilly was part of the working group that developed the International Liver Transplantation Society consensus statements.

Infectious Disease Advisor: What is your perspective on using antiviral therapy to treat HCV in a candidate for liver transplant? Are there any benefits or risks?

Leslie B. Lilly, MD, FRCPC: In general, patients infected with hepatitis C should be treated early enough in their disease course that progression to cirrhosis, liver failure, and liver cancer can be avoided. Patients with cirrhosis who show no signs of liver failure or who have mild signs may benefit from treatment and avoid liver transplantation. Patients referred and listed with very advanced disease are less likely to benefit, and treatment should be deferred until after transplantation. Where the line is drawn is still debated, and it is important that the treating physician is in communication with the transplant program as that decision is made. 

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In The News
July 14, 2017
Sofosbuvir reduces transplant rate in HCV patients
Patients infected with hepatitis C virus (HCV) who have decompensated liver disease should be treated with a sofosbuvir-based regimen, according to a new study.

Direct-acting antiviral agents (DAAs) have transformed the treatment of chronic HCV infection.

“This is the first study to demonstrate the impact of DAAs in this sick population in the context of multiple clinical trials and comparing to a group of control patients who were not treated,” senior author Michael Charlton, MD, associate director of Intermountain Medical Center Transplant Program in Salt Lake City, Utah, told Medical Economics.

Recommended Reading
Wednesday, April 26, 2017
International Liver Transplantation Society Consensus Statement on Hepatitis C Management in Liver Transplant Candidates
An expert panel from ILTS reviews the approach to management of HCV in the transplant recipient in the era of direct-acting anti-virals.