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HCV Antiviral Therapy in Liver Transplant Candidates and Recipients With Renal Insufficiency

Verna, Elizabeth C. MD, MS1; Brown, Robert S. Jr MD, MPH1

doi: 10.1097/TP.0000000000001688

Abstract: Hepatitis C virus (HCV) remains the leading indication for liver transplant in much of the world and has traditionally been associated with diminished posttransplant survival due to recurrent HCV-related liver disease. This field has been dramatically changed by the advent of safe and effective direct-acting antiviral therapy, such that most patients can be cured in the pretransplant or posttransplant setting. In addition, there are now direct-acting antiviral regimens specifically approved for use in patients with severe renal insufficiency. However, patients with pre or posttransplant severe renal insufficiency remain more difficult to treat, due to mechanisms of drug metabolism in hepatic and renal failure, as well as posttransplant drug-drug interactions. Treatment options are even more restricted in non-1 HCV genotypes. Because renal insufficiency is common among patients with HCV, with decompensated cirrhosis, and in the posttransplant setting, this difficult scenario is relatively common. However, ongoing development of pangenotypic regimens with improved safety profiles, as well as additional data on dosing and safety among patients with severe renal insufficiency, will continue to expand options for cure even in these most difficult to treat patients.

The authors provide an update review on anti-HCV therapy in a group of patients that still have limited treatment options, those with renal failure in the peri-liver transplant setting.

1 Center for Liver Disease and Transplantation, New York Presbyterian Hospital, New York, NY.

Received 10 December 2016. Revision received 3 February 2017.

Accepted 8 February 2017.

E.C.V. Grant support form Salix Pharmaceuticals.

R.S.B. Consulting and grants Abbvie, Gilead, BMS, Merck.

E.C.V. and R.S.B. both contributed to the writing and editing of this review.

Correspondence: Robert S. Brown, Jr., MD, MPH, Division of Gastroenterology & Hepatology Weill Cornell Medicine Center for Liver Disease 1305 York Avenue, 4th Floor New York, NY 10021. (

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