Treatment strategies for chronic hepatitis C prior to and following liver transplantation

Readmission following liver transplantation: an unwanted occurrence but an opportunity to act

“…Furthermore, given the safety and efficacy of new direct acting antiviral (DAA) therapies, treatment prior to transplant as well as preemptively after transplant may ultimately help decrease readmissions in these patients although the impact is unknown at this time. 9,10 Although the additional finding of increased length of stay during index hospitalization was concordant with prior investigations, 7 the protective factors noted in the current study including age and male sex, have not been identified by others. Although speculative, it is possible that these factors may be protective due to differences in social support structures upon discharge.…”

Treatment of patients waitlisted for liver transplant with all‐oral direct‐acting antivirals is a cost‐effective treatment strategy in the United States

“…It should be noted that while our analysis demonstrates the clinical effectiveness and cost-effectiveness of a pre-LT treatment strategy, additional considerations for this treatment decision exist. (38)(39)(40) Most notably, while pre-LT treatment will prevent post-LT HCV recurrence, it will at the same time preclude the use of an HCV-positive liver graft, which may further impact upon the probability of transplant for patients who achieve SVR. This perspective was not explicitly considered in this analysis, and further research is necessary to address this question.…”

PRO: Patients With Decompensated Cirrhosis Listed for Liver Transplantation Should Be Treated Pretransplant

“…The question of treating patients awaiting LT with high MELD score is one of an ongoing debate because treatment may improve their MELD score and put them below the threshold for LT, but not help patients improve their overall health . However, we assert that this is not one size fits all.…”

“…With the shortage of donor livers in certain regions, pretreatment with DAA could reduce the need for LT, prevent graft infection, and improve post-LT outcomes. 6,[8][9][10] In a microsimulation study using data from the United Network for Organ Sharing and the SOLAR-1 and −2 trials, Chhatwal et al 11 suggest that the optimal threshold for pretransplantation treatment of decompensated patients is a MELD score between 23 and 27. This further supports the fact that patients below this threshold will benefit from pretransplantation treatment.…”