Preventing recurrent HCV after transplantation: treatment of people on the transplant waiting list

Some people, such as those with HCC or very advanced liver failure, require liver transplantation regardless of whether hepatitis C is present or not, and receiving treatment while on the waiting list is unlikely to impact the timing or outcome of liver transplantation. A decision as to whether to treat a patient on the waiting list, or wait until after transplantation, should be made on a case-by-case basis by a liver transplant physician. Treatment regimen and duration should be chosen according to recommendations for treatment of compensated cirrhosis (for patients with HCC) or decompensated cirrhosis (see Treatment for chronic hepatitis C and treatment of decompensated liver disease).

If a decision is made to treat a patient while awaiting liver transplantation, a period of at least 30 days with undetectable HCV RNA during treatment is associated with a very low risk of recurrence of HCV after transplantation.[71] People treated for ≥ 12 weeks, with a period of undetectable serum HCV RNA of ≥ 8 weeks, can have antiviral treatment stopped at transplantation. For people treated for < 12 weeks before transplant, treatment should continue after transplantation until a total treatment duration of 12 weeks has been achieved. The development of severe acute kidney injury may lead to an interruption of dosing if the person is taking a sofosbuvir-containing regimen. Potential drug–drug interactions in the post-transplant setting should be considered.