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.
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.