Hepatitis C: Liver transplants

Hepatitis C and liver transplants

People with chronic hepatitis C generally receive transplants if their life expectancy is clearly reduced due to liver dysfunction – and if a suitable donor organ is available. In Europe, organs are allocated according to need: whoever is at the greatest risk of dying will receive the next organ which becomes available.

However, since the introduction of interferon-free treatment with direct-acting antivirals, there is some evidence that the number of people who need a liver transplant due to hepatitis C is beginning to fall. In the majority of people with cirrhosis, curing hepatitis C is likely to stop the progression of liver disease and greatly reduce the likelihood that a liver transplant will be needed in the future.

In people with the most advanced form of cirrhosis (decompensated cirrhosis), curing hepatitis C may still leave a person with a liver that is functioning very poorly. In this case a liver transplant will still be needed.

Glossary

cirrhosis

Scarring of the liver – the structure of the liver is altered. See also ‘fibrosis’, which is moderate scarring. See also ‘compensated cirrhosis’ and ‘decompensated cirrhosis’.

interferon-free

A treatment regimen that does not include pegylated interferon.

In some people with advanced cirrhosis, either hepatitis C is not cured prior to a liver transplant or it is not possible to provide treatment for hepatitis C prior to a liver transplant. Chronic hepatitis C infection cannot be cured by liver-transplant alone. Without direct-acting antiviral treatment the donor organ becomes reinfected within just a few hours. The disease may take a more aggressive course after the transplant. Liver disease advances more quickly in liver-transplant patients who have a high viral load. This is in contrast to patients who have not had a transplant, in whom viral load does not predict disease progression.1 A third of liver-transplant patients develop cirrhosis again within five years if hepatitis C is not cured.2

Liver-transplant patients with chronic hepatitis C can be treated with direct-acting antivirals to clear hepatitis C infection after a liver transplant. Early studies have shown very high cure rates (above 90%) in people treated with direct-acting antivirals after liver transplant. It is not essential to treat hepatitis C immediately after transplantation and in most cases doctors will monitor the progress of liver damage and wait for a person to recover from a transplant before suggesting hepatitis C treatment.

This information was originally adapted from Hepatitis C: Understanding a silent killer, published by the European Liver Patients Association. It was updated in 2016.

References

  1. Roche B et al. Risk factors for hepatitis C recurrence after liver transplantation. J Viral Hepat. Nov;14Suppl 1:89-96, 2007
  2. EASL Clinical Practice Guidelines: Management of hepatitis C virus infection. J Hepatol 55:245-264, 2011
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