Consensus recommendations

Consensus recommendations

Grade

Indications for assessment by a liver transplant centre include a Child–Pugh score ≥ B7, MELD score ≥ 13 or one of the following clinical events: refractory ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, recurrent or chronic hepatic encephalopathy, small HCC or severe malnutrition.

A1

People with decompensated HCV cirrhosis, Child–Pugh score B and MELD score < 15 should be assessed by an expert hepatologist for consideration of treatment as soon as possible, as they are at risk of further decompensation and liver-related complications and death, which may be prevented by eradicating HCV.

B2

People with decompensated HCV cirrhosis, Child–Pugh score B or C and MELD score > 15 (who are NOT liver transplant candidates) should be assessed by an expert hepatologist for consideration of treatment where there is an anticipated benefit from such treatment.

B1

People with decompensated HCV cirrhosis, Child–Pugh score B or C and MELD score > 15 (who ARE liver transplant candidates) should be assessed by a liver transplant physician to consider the individual benefit and risks of treatment before transplantation.

B2

When making treatment decisions, decompensated liver disease should be defined by a Child–Pugh score ≥ B7.

A1

First-line treatment regimens for chronic Gt 1 HCV infection and decompensated liver disease include (see Table 6):

  • sofosbuvir + velpatasvir + ribavirin for 12 weeks
  • sofosbuvir + ledipasvir ± ribavirin for 12 or 24 weeks
  • A1
  • A1
  • sofosbuvir + daclatasvir ± ribavirin for 12 or 24 weeks
  • B1

First-line treatment regimen for chronic Gt 3 HCV infection and decompensated liver disease are (see Table 6):

  • sofosbuvir + velpatasvir + ribavirin for 12 weeks
  • sofosbuvir + daclatasvir ± ribavirin for 12 or 24 weeks
  • A1
  • B1

The first-line treatment regimen for chronic Gt 2, 4–6 HCV infection in the setting of decompensated liver disease is (see Table 6):

  • sofosbuvir + velpatasvir + ribavirin for 12 weeks
  • A1

The following treatments should NOT BE USED in people with decompensated liver disease:

  • sofosbuvir + velpatasvir + voxilaprevir
  • glecaprevir + pibrentasvir
  • paritaprevir–ritonavir, ombitasvir and dasabuvir
  • elbasvir + grazoprevir
  • pegIFN

A1