Treatment of hepatitis C in the potential liver transplant recipient

Despite the availability of antiviral treatment, chronic hepatitis C-related cirrhosis and hepatocellular carcinoma remain major indications for liver transplantation. Antiviral treatment should be administered to render the patient aviremic if possible before transplant. Hepatitis C recurrence after liver transplant is a major cause of morbidity, mortality, and graft loss, and treatment is problematic after transplant. Hence, treatment of the cirrhotic patient must be considered. However, this remains a challenge because cirrhotic patients tend to have a poorer response rate and their clinical condition limits the therapeutic doses that can be used. Other methods of treatment include low-dose maintenance therapy or low, escalating dose regimens. Sustained virologic response rates are suboptimal, and side effects often require dose reduction or treatment discontinuation. Newer antivirals are anxiously awaited to treat this challenging group of patients.