Use of direct-acting antiviral agents in hepatitis C virus-infected liver transplant candidates

Table 1 Advantages and disadvantages of hepatitis C virus treatment in liver transplant candidates before liver transplantation

Advantages	Disadvantages
1. Liver function and MELD score may improve	1. MELD score may improve but with ongoing poor health (MELD purgatory)
2. Liver transplantation may no longer be necessary	2. Possibly eliminates the option of a curative treatment for liver disease
3. Societal benefits given the scarcity of organs and limited donor pool	3. May limit access to HCV-positive donors, thereby prolonging the transplant waitlist time and risk of dropout or death
4. Prevent post-transplant recurrence of HCV	4. If treatment fails, risk of resistance to NS5A inhibitors and compromised SVR rates when re-treating after liver transplantation
5. Cost savings if liver transplantation can be obviated

HCV: Hepatitis C virus; SVR: Sustained virological response; MELD: Model for end-stage liver disease.