Treating HCV prior to liver transplantation

The main goals of treating patients with chronic hepatitis C virus (HCV) infection who are listed for liver transplantation (LT) are: (1) to stabilize disease to reduce the need for LT, (2) to prevent HCV recurrence in the allograft, and (3) to improve graft survival. However, antiviral treatment of HCV-infected patients with advanced disease is limited by poor tolerability and the risk for treatment to increase the risk for hepatic decompensation and even death. Current guidelines suggest that patients with MELD £ 18 could be treated with antiviral therapy by clinicians experienced with treatment in the setting of advanced liver disease [1, 2]. On the basis of the recent OPTN data, more than half of the 5,627 patients infected with HCV currently listed for transplantation have a model for end-stage liver disease (MELD) score of £ 18 and would be potentially eligible for pre-transplant antiviral therapy. In this chapter, we describe the benefi ts and risks of pre-transplant antiviral therapy for HCV-infected patients who are waiting for liver transplantation.