title: Perspectives on treating hepatitis C infection in the liver transplantation setting.
abstract: OBJECTIVE
  This article reviews treatment options of the approved and soon-to-be approved direct-acting antiviral (DAA)-based therapies in the transplant setting.
  
  
  RESULTS
  DAA-based therapies have been shown to be effective and safe in achieving viral eradication in the majority of pre- and postliver transplant (LT) populations. Treatment decisions are guided by hepatitis C virus (HCV) genotype, the degree of renal dysfunction, and severity of cirrhosis. The addition of ribavirin is frequently needed to achieve highest viral eradication rates. Viral eradication pre-LT has been associated with fewer portal hypertensive complications and improved survival and effectively prevents recurrent HCV post-LT. For those with shorter time to LT, an alternative strategy is treatment with DAAs up to the time of LT to reduce the risk of post-LT recurrence. Therapies should be considered for all post-LT patients with recurrent HCV given the risk of accelerated disease progression. The sustained virological response rates among LT recipients parallel those of nontransplant patients.
  
  
  CONCLUSIONS
  With broader application of DAA therapy in the transplant setting, improved graft and patient survival and simplified post-LT management are likely. The availability of high potency DAA therapy with excellent safety profiles has transformed the HCV-infected LT population into a group that is no longer 'difficult-to-treat.'
authors.affiliation: Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA.
authors.forename: Tianyan
authors.initials: T
authors.lastname: Chen
authors.forename: Norah A
authors.initials: NA
authors.lastname: Terrault
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D016174:Hepacivirus / Q000187:drug effects / Q000235:genetics; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000821:virology; D016031:Liver Transplantation; D012008:Recurrence
chemical_list: D000998:Antiviral Agents