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Ofosu, Andrew; Durand, Christine M.; Saberi, Behnam; Alqahtani, Saleh A.; Üçbilek, Enver; Belden, Maura; Cameron, Andrew; Gürakar, Ahmet

doi:10.6002/ect.tdtd2015.l16

Cited by 4 publications

(1 citation statement)

References 19 publications

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“…The proportion of HCV-positive donors in the local regional donor pool is an important factor to consider prior to treatment. 29 In a single-center retrospective review of all deceased-donor transplants, Ofosu et al 30 observed that 40% of their HCV-seropositive recipients ultimately received transplants from HCV-positive donors. This number is likely to vary by region but should be considered when pursuing HCV treatment in a LT candidate.…”

Section: Treatment Of Hcv Prior To Liver Transplantationmentioning

confidence: 99%

Timing of Hepatitis C Virus Treatment in Liver Transplant Candidates in the Era of Direct-acting Antiviral Agents

Cholankeril

Joseph-Talreja

Perumpail

et al. 2017

Journal of Clinical and Translational Hepatology

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Chronic hepatitis C virus (HCV) infection remains the leading indication for liver transplantation (LT) in the United States. While most patients with chronic HCV infection remain asymptomatic, up to one-third develop progressive liver disease resulting in cirrhosis. LT is often the only curative treatment once significant hepatic decompensation develops. However, antiviral therapy for HCV infection has advanced markedly in the past 5 years with the discovery and approval of direct-acting antiviral agents. These new regimens are well tolerated, of short duration and highly effective, unlike the traditional treatment with pegylated-interferon and ribavirin. As achieving sustained virological response becomes increasingly attainable for a majority of HCV-infected patients, concerns have been raised regarding the optimal timing of treatment for HCV infection in the setting of end-stage liver disease and during the peri-transplant period. On one hand, HCV treatment may improve hepatic function and negate the need for LT in some, which is crucial given the scarcity of donor organs and mortality on the waiting list in certain regions. On the other hand, HCV treatment may result in lowering the priority for LT without improving quality of life, thereby delaying potentially curative LT surgery. This review evaluates the evidence supporting the use of direct-acting antiviral agents in the period before and following LT.

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Section: Treatment Of Hcv Prior To Liver Transplantationmentioning

confidence: 99%

Timing of Hepatitis C Virus Treatment in Liver Transplant Candidates in the Era of Direct-acting Antiviral Agents

Cholankeril

Joseph-Talreja

Perumpail

et al. 2017

Journal of Clinical and Translational Hepatology

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Considerations When Treating Hepatitis C in a Cirrhotic Transplant Candidate

Daniel

Said

2018

Curr Gastroenterol Rep

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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. 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.

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