The road map toward an hepatitis C virus‐free transplant population |
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| Authors: | M. Berenguer K. Agarwal P. Burra M. Manns D. Samuel |
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| Affiliation: | 1. Liver Transplantation & Hepatology Unit, Hospital Universitario La Fe, University of Valencia‐CIBEReHD, Valencia, Spain;2. Institute of Liver Studies, King's College Hospital, London, UK;3. Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy;4. Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany;5. Inserm‐Paris Sud Unit 1193, Centre Hepatobiliaire, Hopital Paul Brousse, Villejuif, France |
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| Abstract: | Antiviral therapy to eradicate hepatitis C virus (HCV) infection improves outcomes in patients undergoing liver transplantation (LT) for advanced chronic HCV with or without hepatocellular carcinoma. Traditionally, antiviral therapy focused on the use of interferon (IFN)‐based regimens, with antiviral treatment initiated in the posttransplant period once recurrent HCV disease with fibrosis in the allograft was identified. The use of IFN‐based therapy was limited in pretransplant patients with advanced liver disease. Earlier intervention, either before transplantation or early after LT, is now feasible with the advent of second‐generation direct‐acting antiviral agents (DAAs) with superior tolerability and efficacy to IFN‐based therapy. These agents have the potential to reduce the number of patients developing HCV‐related complications requiring LT and retransplantation, as well as reducing the demand for donor organs. We discuss the pros and cons of pretransplant, peritransplant, and posttransplant therapy with current DAAs, citing available data from clinical trials and real‐world experience. |
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| Keywords: | clinical research/practice editorial/personal viewpoint infection and infectious agents— viral: hepatitis C infectious disease liver disease: infectious liver transplantation/hepatology |
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