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Hepatocellular carcinoma in the wait-listed patient with hepatitis C virus

Prenner, Stacey B.a; Kulik, Laurab

Current Opinion in Organ Transplantation: April 2018 - Volume 23 - Issue 2 - p 237–243
doi: 10.1097/MOT.0000000000000505
CONTROVERSIES IN ORGAN TRANSPLANTATION: Edited by Norah A. Terrault
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Purpose of review To highlight the current data for treatment of hepatitis C virus (HCV) in patients with hepatocellular carcinoma (HCC) awaiting orthotopic liver transplant and incorporation of various factors to decide the optimal time to initiate HCV therapy.

Recent findings Viral eradication on the waiting list has been found to lead to significant clinical improvement in approximately 20% of HCV-positive patients. However, there have been concerns raised for direct-acting antiviral (DAA) therapy in patients listed with HCC. DAA therapy leading to rapid HCV clearance has been reported to be associated with an increased risk of HCC recurrence, especially when DAA therapy is initiated in close proximity to HCC therapy. Additionally, the presence of viable HCC may significantly lower the chances of achieving sustained virologic response. Lastly, sustained virologic response can decrease the organ pool in HCV-positive waitlisted patients.

Summary The decision to treat HCV in patients listed for HCC pre vs. postliver transplant will require additional research.

aDivision of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

bDivision of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Chicago, Illinois, USA

Correspondence to Laura Kulik, MD, 676 N. St. Clair, 19th Floor, Chicago, IL, USA. Tel: +1 312 695 9286; e-mail: lkulik@nm.org

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