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World J Gastroenterol. Jan 21, 2018; 24(3): 315-322
Published online Jan 21, 2018. doi: 10.3748/wjg.v24.i3.315
Use of direct-acting antiviral agents in hepatitis C virus-infected liver transplant candidates
Chiranjeevi Gadiparthi, George Cholankeril, Brandon J Perumpail, Eric R Yoo, Sanjaya K Satapathy, Satheesh Nair, Aijaz Ahmed
Chiranjeevi Gadiparthi, Sanjaya K Satapathy, Satheesh Nair, Division of Gastroenterology and Hepatology, University of Tennessee Health Sciences Center, Memphis, TN 38104, United States
George Cholankeril, Aijaz Ahmed, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94304, United States
Brandon J Perumpail, Drexel University College of Medicine, Philadelphia, PA 19129, United States
Eric R Yoo, Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128, United States
Author contributions: All authors contributed to study concept and design, acquisition of data, analysis and interpretation of data, drafting, editing, and critical revision of manuscript and, and approval of final version.
Conflict-of-interest statement: The authors have no conflict of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Aijaz Ahmed, MD, Associate Professor, Attending Doctor, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road, Suite 210, Palo Alto, CA 94304, United States. aijazahmed@stanford.edu
Telephone: +1-650-4986091 Fax: +1-650-4985692
Received: November 7, 2017
Peer-review started: November 7, 2017
First decision: November 30, 2017
Revised: December 5, 2017
Accepted: December 12, 2017
Article in press: December 12, 2017
Published online: January 21, 2018
Abstract

Since the advent of direct acting antiviral (DAA) agents, chronic hepatitis C virus (HCV) treatment has evolved at a rapid pace. In contrast to prior regimen involving ribavirin and pegylated interferon, these newer agents are highly effective, well-tolerated, have shorter course of therapy and safer essentially in all HCV patients including those with advanced liver disease and following liver transplantation. Clinicians caring for HCV-infected patients on the liver transplant (LT) waitlist are often faced with a dilemma whether to treat HCV infection before or after liver transplantation. Sustained virological response (SVR) rates following HCV treatment may improve hepatic function sufficiently enough to negate the need for LT in certain patients. On the other hand, the decrease in MELD without improvement in quality of life in certain patients may lead to delay or dropout from potentially curative LT surgery list. In this context, our review focuses on the approach to and optimal timing of DAA-based treatment of HCV infection in LT candidates in the peri-transplant period.

Keywords: Hepatitis C virus, Direct-acting antiviral therapy, Liver transplantation, Purgatory Model for End-stage liver disease, Sustained virological response

Core tip: Optimal timing of antiviral therapy for hepatitis C virus (HCV) infection in liver transplant candidates using second generation direct-acting antivirals is debated. Available evidence lacks conviction if the viral eradication is beneficial in all HCV patients before liver transplantation. We aim to review the current literature to better delineate the appropriate timing of HCV treatment in the era of direct-acting antiviral agents.