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Treating HCV Prior to Liver Transplantation

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Chronic Hepatitis C Virus

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Abstract

Chronic hepatitis C virus (HCV) infection is the leading indication for liver transplantation in the United States. Recurrence of HCV infection is universal in recipients who are HCV RNA positive prior to liver transplantation. Recurrent HCV infection can be aggressive, and it leads to allograft failure within a few years after transplantation. These patients are “difficult-to-treat” due to poor tolerability of peginterferon and ribavirin, and they are “difficult-to-cure” due to reduced efficacy of therapy. Clearing HCV prior to liver transplantation has the potential to significantly improve the patients’ post-transplantation course. Therefore, the major goals for pre-transplant treatment are stabilization of liver disease to reduce the need for transplantation, reduction of the risk for post-transplantation HCV recurrence, and improvement in allograft survival. This chapter reviews the evidence that supports each treatment goal and explains why an attempt to treat these patients is warranted. This chapter also provides recommendations for the current management of patients on the waiting list using the Low Accelerating Dose Regimen (LADR). In addition, we briefly discuss the future directions of antiviral therapy including direct-antiviral acting therapies, and the potential benefits that newer treatments could provide to this select group of patients.

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Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, University of Colorado Denver, 12631 East 17th Avenue, Aurora, CO, 80045, USA

    Alvaro Martinez-Camacho MD & Brett E. Fortune MD

  2. Department of Internal Medicine, University of Colorado Denver, 1635 Aurora Court, B-154, Aurora, CO, 80045, USA

    Gregory T. Everson MD

Authors
  1. Alvaro Martinez-Camacho MD
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  2. Brett E. Fortune MD
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  3. Gregory T. Everson MD
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Corresponding author

Correspondence to Gregory T. Everson MD .

Editor information

Editors and Affiliations

  1. Bon Secours Health System, Liver Institute of Virginia, McManus Blvd., Suite 313 12720, Newport News, 23602, Virginia, USA

    Mitchell L. Shiffman

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Martinez-Camacho, A., Fortune, B.E., Everson, G.T. (2012). Treating HCV Prior to Liver Transplantation. In: Shiffman, M. (eds) Chronic Hepatitis C Virus. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1192-5_24

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  • DOI: https://doi.org/10.1007/978-1-4614-1192-5_24

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-1191-8

  • Online ISBN: 978-1-4614-1192-5

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