HCV in liver transplant

 Q: Patients with Hepatitis C (HCV) viremia who goes for a liver transplant, the reinfection is almost always with the same strain of the virus as prior to the transplant?

A) True

B) False

Answer: A

The major decision in patients with HCV who goes for liver transplant is to establish the timing for the HCV treatment. It can be either before or after the transplant. It is individualized by the transplant team. Various factors come into consideration such as the Child-Pugh class for cirrhosis, and likelihood of meaningful clinical as well as viremic response before transplant. The biggest caveat in treating HCV prior to transplant is the improvement in Model for End-Stage Liver Disease (MELD) score without any clinical improvement. This may harm the patients by increasing their wait time. 

Treatment of HCV after transplant is possible due to safe and effective HCV therapy with direct-acting antivirals (DAAs). The reinfection of donor's liver is almost always with the same strain of the virus as prior to the transplant.

#transplantation

#hepatology

References: 

1. Wright TL, Donegan E, Hsu HH, et al. Recurrent and acquired hepatitis C viral infection in liver transplant recipients. Gastroenterology 1992; 103:317. 

2. Cholankeril G, Joseph-Talreja M, Perumpail BJ, et al. Timing of Hepatitis C Virus Treatment in Liver Transplant Candidates in the Era of Direct-acting Antiviral Agents. J Clin Transl Hepatol. 2017;5(4):363-367. doi:10.14218/JCTH.2017.00007 

3. Chhatwal J, Samur S, Kues B, Ayer T, Roberts MS, Kanwal F, Hur C, Donnell DM, Chung RT. Optimal timing of hepatitis C treatment for patients on the liver transplant waiting list. Hepatology. 2017 Mar;65(3):777-788. doi: 10.1002/hep.28926. Epub 2017 Jan 6. PMID: 27906468; PMCID: PMC5319880.