title: The future of liver transplantation for viral hepatitis.
abstract: In hepatitis C virus (HCV)-infected patients, transplantation can be justified by decompensated cirrhosis, hepatocellular carcinoma (HCC) or both. During the last decade, HCV infection accounted for about 30% of the indications for transplantation in Europe and North America. Direct antiviral agents (DAAs) are highly effective at curing HCV, even in patients with end-stage cirrhosis. In the future, the incidence of HCV-related decompensated cirrhosis will continue to decrease. The incidence of HCC will also decrease, but a large cohort of patients with cirrhosis will still be at risk of developing HCC even after HCV has been cured. They will continue to represent potential candidates for transplantation. Overall, HCV will account for a significantly lower proportion of indications for transplantation in the future. However, generalization of DAAs is unlikely to affect the total transplantation volume as the gap between donors and potential recipients markedly exceeds 30%. In addition, non-alcoholic steatohepatitis (NASH) is a rapidly growing indication for transplantation. The high barrier to resistance nucleos(t)ide analogues (NUCs) have been used for several years to treat hepatitis B virus (HBV) infection. Decompensated HBV cirrhosis now represents a very uncommon indication for transplantation. HCC remains the leading indication in HBV-infected patients awaiting transplantation. NUCs plus anti-HBs immune globulins or NUCs alone are highly effective at preventing post-transplant HBV recurrence. However, continuous prophylaxis is still needed as extrahepatic HBV particles persist with a potential for recurrence. Post-transplant immunosuppression facilitates recurrence. In the future, an important challenge will be to cure HBV by eliminating residual HBV particles.
authors.affiliation: Hepatology and Liver Intensive Care, Hospital Beaujon, INSERM U1149, University Paris Diderot, Clichy, France.
authors.forename: François
authors.initials: F
authors.lastname: Durand
authors.affiliation: Hepatology and Liver Intensive Care, Hospital Beaujon, INSERM U1149, University Paris Diderot, Clichy, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Francoz
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000821:virology; D019694:Hepatitis B, Chronic / Q000517:prevention & control; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000821:virology; D017093:Liver Failure / Q000601:surgery* / Q000821:virology; D008113:Liver Neoplasms / Q000821:virology; D016031:Liver Transplantation / Q000639:trends*; D065626:Non-alcoholic Fatty Liver Disease / Q000821:virology; D018579:Patient Selection; D011183:Postoperative Complications / Q000517:prevention & control
chemical_list: D000998:Antiviral Agents
keywords: direct antiviral agents; hepatitis C virus; hepatocellular carcinoma; non-alcoholic steatohepatitis