Use of direct-acting antiviral agents in hepatitis C virus-infected liver transplant candidates

Minireviews World J Gastroenterol. Jan 21, 2018; 24(3): 315-322
Published online Jan 21, 2018. doi: 10.3748/wjg.v24.i3.315

Use of direct-acting antiviral agents in hepatitis C virus-infected liver transplant candidates

Chiranjeevi Gadiparthi, George Cholankeril, Brandon J Perumpail, Eric R Yoo, Sanjaya K Satapathy, Satheesh Nair, Aijaz Ahmed

Published online: January 21, 2018

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Abstract
Since the advent of direct acting antiviral (DAA) agents, chronic hepatitis C virus (HCV) treatment has evolved at a rapid pace. In contrast to prior regimen involving ribavirin and pegylated interferon, these newer agents are highly effective, well-tolerated, have shorter course of therapy and safer essentially in all HCV patients including those with advanced liver disease and following liver transplantation. Clinicians caring for HCV-infected patients on the liver transplant (LT) waitlist are often faced with a dilemma whether to treat HCV infection before or after liver transplantation. Sustained virological response (SVR) rates following HCV treatment may improve hepatic function sufficiently enough to negate the need for LT in certain patients. On the other hand, the decrease in MELD without improvement in quality of life in certain patients may lead to delay or dropout from potentially curative LT surgery list. In this context, our review focuses on the approach to and optimal timing of DAA-based treatment of HCV infection in LT candidates in the peri-transplant period.

Core tip: Optimal timing of antiviral therapy for hepatitis C virus (HCV) infection in liver transplant candidates using second generation direct-acting antivirals is debated. Available evidence lacks conviction if the viral eradication is beneficial in all HCV patients before liver transplantation. We aim to review the current literature to better delineate the appropriate timing of HCV treatment in the era of direct-acting antiviral agents.

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