Strategy for Hepatitis C Treatment in Liver Transplant Settings

In patients with detectable virus at the time of liver transplantation, hepatitis C virus (HCV) infection always recurs on the graft, and 30% of patients have an aggressive clinical and histologic course with increased morbidity, mortality, and graft loss. Moreover, in some transplantation patients, recurrent HCV infection leads to an aggressive course of disease known as fibrosing cholestatic hepatitis, which is characterized by hepatic decompensation and death. Liver allograft and recipient survival can be substantially improved with successful eradication of HCV. Recent advances in direct-acting antiviral agents have revolutionized the management of HCV infection, and a number of these agents have shown high sustained virological responses, shorter durations of treatment, and much improved tolerability when compared with previous pegylated interferon based therapies in liver transplant settings.