ELITA consensus statements on the use of DAAs in liver transplant candidates and recipients.
The advent of safe and highly effective direct-acting antiviral agents (DAAs) has had huge implications for the hepatitis C virus (HCV) transplant field, and changed our management of both patients on the waiting list and those with HCV graft re-infection after liver transplantation (LT). When treating HCV infection before LT, HCV re-infection of the graft can be prevented in nearly all patients. In addition, some candidates show a remarkable clinical improvement and may be delisted. Alternatively, HCV infection can be treated post-LT either soon after the transplant, taking advantage of the removal of the infected native liver, or at the time of disease recurrence, as was carried out in the past. In either case, some DAAs have a limited use because of their drug to drug interactions with various immunosuppressants as well as the many other drugs liver transplant recipients are often prescribed. In addition, some DAAs should be avoided in case of severe renal failure, which is not an unusual complication after LT. The present document provides a series of consensus statements on the LT issues that have not been extensively addressed previously. These statements have been developed to support physicians and other stakeholders in charge of LT candidates and recipients when deciding to treat HCV, especially in difficult situations.
Department of Hepatology and Gastroenterology, Niguarda Hospital, Italy; International Centre for Digestive Health, School of Medicine and Surgery, University of Milano Bicocca, Italy. Electronic address: luca.belli@ospedaleniguarda.it.
Luca S
LS
Belli
Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est University, Creteil, France.
Christophe
C
Duvoux
Hepatology& Liver Transplantation Unit, Hospital Universitari I Politècnic La Fe, University of Valencia & Ciberhed, Valencia, Spain.
Marina
M
Berenguer
Section of Hepatology, Clinic for Gastroenterology and Rheumatology, University Clinic Leipzig, Germany.
Thomas
T
Berg
Centre Hepato-Biliaire,Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, Villejuif, France.
Audrey
A
Coilly
Hepatology and Gastroenterology, Unversity of Gent, Belgium.
Isabelle
I
Colle
Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Stefano
S
Fagiuoli
Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool.
Saye
S
Khoo
Department of Hepatology, Gastroenterology, and Liver Transplantation, Centre Hospitalier Universitaire, Saint Eloi, Montpellier, France.
Georges Philippe
GP
Pageaux
Department of Infective Diseases. Niguarda Hospital, Milan, Italy.
Massimo
M
Puoti
Centre Hepato-Biliaire,Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, Villejuif, France.
Didier
D
Samuel
International Centre for Digestive Health, School of Medicine and Surgery, University of Milano Bicocca, Italy; Yale University Liver Center, Department of Medicine New Haven, USA.
Mario
M
Strazzabosco
D000998:Antiviral Agents / Q000627:therapeutic use*; D004347:Drug Interactions; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D016031:Liver Transplantation
D000998:Antiviral Agents
Antiviral agents; Guidelines; Hepatitis C, chronic; Interferons; Liver failure; Liver transplant candidate; Liver transplant recipient; Liver transplantation; Recurrent hepatitis C; Waiting lists