Hepatitis C in Liver Transplantation

Liver transplantation is the ultimate therapy for patients with advanced liver disease and hepatitis C. Hepatitis C is now the common indication for transplantation across the world. Despite the utility of liver transplantation, survival for patients transplanted for hepatitis C is among the lowest for all indications. Recurrent infection is universal, and disease can result in graft failure within 5 years in up 20% of transplant recipients. There are a number of modifiable and non-modifiable risk factors for disease progression. Antiviral therapy can result in a sustained viral response (SVR) in approximately a third of treated patients, and can lead to improved patient and graft survival. However, treatment adherence and tolerability is limited by a number of adverse effects. There is much interest in the next generation of direct acting agents which may be associated with improved tolerability, increased SVR rates, decreased drug interactions, and generalized genotype activity.