Pre- and Post-Transplant Treatment of Viral Hepatitis C

Background: Hepatitis C (HCV) is a common cause of liver failure and liver cancer, and is a frequent indication for liver transplantation (LT). Until recently, a majority of transplanted patients were viraemic at the time of transplantation and they inevitably underwent recurrent infection of the graft. Prior to the availability of specific direct-acting antiviral (DAA) drugs, HCV infection was seldom successfully treated before or after transplantation. Key Messages: During the past 2 years, the use of interferon-free DAA therapy has transformed the management of patients post-LT and of patients on the transplant waiting list. DAA treatment post-LT can eradicate infection and normalize liver function tests in a majority of treated patients. An improvement in long-term graft and patient outcome can be anticipated. DAA treatment of patients with liver failure awaiting LT eliminates infection and is associated with an improvement in the liver function for a majority of treated patients. The majority still require transplantation, though some may improve sufficiently and quickly enough to be removed from the LT waiting list. Conclusions: Eventually, as greater numbers of patients with compensated cirrhosis are successfully treated with DAAs, HCV-associated liver failure may become an uncommon indication for LT.