Perumpail RB, Hahambis TA, Aggarwal A, Younossi ZM, Ahmed A. Treatment strategies for chronic hepatitis C prior to and following liver transplantation. World J Hepatol 2016; 8(1): 69-73 [PMID: 26783422 DOI: 10.4254/wjh.v8.i1.69]
Corresponding Author of This Article
Ryan B Perumpail, MD, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road, Suite 210, Palo Alto, CA 94304, United States. rperumpail@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
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/
World J Hepatol. Jan 8, 2016; 8(1): 69-73 Published online Jan 8, 2016. doi: 10.4254/wjh.v8.i1.69
Treatment strategies for chronic hepatitis C prior to and following liver transplantation
Ryan B Perumpail, Thomas A Hahambis, Avin Aggarwal, Zobair M Younossi, Aijaz Ahmed
Ryan B Perumpail, Avin Aggarwal, Aijaz Ahmed, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA 94304, United States
Thomas A Hahambis, Gilead Sciences, Foster City, CA 94404, United States
Zobair M Younossi, Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA 22042, United States
Zobair M Younossi, Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA 22042, United States
Author contributions: Perumpail RB prepared first and final draft, revised the final draft based on feedback from other authors; Hahambis TA prepared first and final draft with the first author; Aggarwal A, Younossi ZM and Ahmed A reviewed and revised each segment of the document and checked references for completeness.
Conflict-of-interest statement: Ryan B Perumpail and Avin Aggarwal have no conflict of interest; Thomas A Hahambis is Gilead Employee: Senior Medical Scientist, Hepatitis; Zobair M Younossi is Advisory Board and/or Consultant to Gilead, Abbvie, BMS, GSK, and Intercept; Aijaz Ahmed is Advisory Board: Gilead. Research Funding: Gilead.
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: Ryan B Perumpail, MD, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road, Suite 210, Palo Alto, CA 94304, United States. rperumpail@gmail.com
Telephone: +1-650-4986091 Fax: +1-650-4985692
Received: August 20, 2015 Peer-review started: August 22, 2015 First decision: October 30, 2015 Revised: October 30, 2015 Accepted: December 17, 2015 Article in press: December 18, 2015 Published online: January 8, 2016 Processing time: 140 Days and 6.2 Hours
Abstract
Hepatitis C virus (HCV)-related liver disease is the leading indication for liver transplantation (LT) worldwide. However, HCV is an independent predictor of lower survival following LT, and recurrence of HCV post-LT is virtually universal. The historic standard of care during the interferon era of HCV therapy was expectant management-initiation of antiviral therapy in the setting of documented disease progression following LT. With the advent of new direct acting antiviral (DAA) therapies for HCV, the paradigm of expectant treatment for recurrent HCV infection post-LT is shifting. The safety, tolerability, and efficacy of DAAs, even among the sickest patients with advanced liver disease, enables treatment of HCV in the pre-transplant setting among LT waitlist registrants. Finally, emerging data are supportive of preemptive therapy with DAAs in liver transplant recipients as the preferred approach. Expectant management of HCV following LT can rarely be justified in the modern era of HCV therapy.
Core tip: The historic standard of care during the interferon era of hepatitis C virus (HCV) therapy was expectant management-initiation of antiviral therapy in the setting of documented disease progression following liver transplantation. With the advent of new direct acting antiviral (DAA) therapies for HCV, the paradigm of expectant treatment for recurrent HCV infection post-liver transplantation (LT) is shifting. The safety, tolerability, and efficacy of DAAs, even among the sickest patients with advanced liver disease, enables treatment of HCV in the pre-transplant setting among LT waitlist registrants. Emerging data support preemptive therapy with DAAs in liver transplant recipients as the preferred approach.
