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Emerging Management of Hepatitis C in Transplant

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Emerging Transplant Infections

Abstract

Chronic hepatitis C virus (HCV) infection related liver diseases are a leading indication for liver transplantation (LT) worldwide, responsible for about 20% of all LT performed in Europe and the United States. In the context of liver transplantation, treatment of HCV infection has been classically challenging because of therapies’ low efficacy and safety concerns associated with interferon-based regimens, so that patients with decompensated cirrhosis and liver graft recipients have been typically considered as “difficult to treat populations.” The arrival of the new direct-acting antiviral agents (DAAs) has transformed the management of these patients. Treating LT candidates not only prevents viral recurrence, but importantly, leads to functional improvement and potential delisting from the waiting list. Efficacy, safety, and tolerability of DAA treatments worsen as the severity of liver disease increases. In the posttransplant setting, DAA therapies now have excellent efficacy and tolerability, so much so that the transplantation of HCV positive donors into HCV negative recipients in some regions of the world is considered a viable option to increase a limited donor pool. This is especially true in North America, where the opiate epidemic has fueled an availability of viable organs for donation.

This review gives an overview of chronic HCV infection and current management strategies and focuses on the use of DAA treatment in the field of LT, both in the pretransplant and the posttransplant period. Data is presented on viability of mismatched viremic donors in different organ groups.

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Acknowledgments

The funding organization Instituto de Salud Carlos III supported the research of both Lorena Puchades (Grant number: CM17/00006) and Marina Berenguer (Grant number PI19/01360).

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Authors and Affiliations

  1. Department of Gastroenterology, Hepatology Unit and Instituto de Investigación La Fe, Hospital Universitari i Politècnic La Fe, Valencia, Spain

    Lorena Puchades & Marina Berenguer

  2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Valencia, Spain

    Lorena Puchades & Marina Berenguer

  3. School of Medicine, University of Valencia, Valencia, Spain

    Marina Berenguer

Authors
  1. Lorena Puchades
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  2. Marina Berenguer
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Corresponding author

Correspondence to Marina Berenguer .

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Editors and Affiliations

  1. Immunocompromised Host Service Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA

    Michele I. Morris

  2. Transplant and Immunocompromised Host Infectious Diseases, Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Camille Nelson Kotton

  3. Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA

    Cameron R. Wolfe

Section Editor information

  1. Duke University, Durham, NC, USA

    Cameron R. Wolfe

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Puchades, L., Berenguer, M. (2021). Emerging Management of Hepatitis C in Transplant. In: Morris, M.I., Kotton, C.N., Wolfe, C.R. (eds) Emerging Transplant Infections. Springer, Cham. https://doi.org/10.1007/978-3-030-25869-6_38

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  • DOI: https://doi.org/10.1007/978-3-030-25869-6_38

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