Direct-acting antiviral treatment for hepatitis C in liver transplant candidates and recipients

Recurrent hepatitis C virus (HCV) infection is universal in liver transplantation (LT) recipients, and the natural course of it is accelerated when compared to non-transplant patients with 15% to 30% of patients progressing to cirrhosis in 5 years from LT and a half of them developing liver failure shortly. The management of recurrent hepatitis C has been challenging in the ear of interferon-based therapies because of limited efficacy and poor tolerability. Consequently the patient and graft survival among HCV positive recipients was impaired by 10% when compared to other indications for LT (1). With the advent of potent and well-tolerated direct-acting antivirals (DAAs), the landscape of HCV treatment has dramatically changed (2). The sustained viral response (SVR) rates of LT recipients have been reported to be over 90%, and the outcome of LT for HCV positive recipients is expected to improve. What is more, DAAs have been shown to be equally effective even for cirrhotic patients who are waitlisted for LT, which poses a new problem; the waitlisted patients should be treated with DAAs during pre-LT period or post-LT period.