Elimination of Hepatitis C in Liver Transplant Recipients

Background and Aims:Recurrent hepatitis C(HCV)disease in liver transplant(LT)recipients is associated with significant morbidity and mortality.With the availability of noninterferon-based therapy,eliminating HCV may be achievable in LT recip-ients.Methods:We studied all consecutive recipients who underwent LT at the University of California Los Angeles be-tween January 2005 and June 2017.We collected data on date of transplant and last follow-up,as well as laboratory values.We also recorded type and timing of antiviral therapy relative to LT.Analyses were performed to assess the proportion of LT recipi-ents who are viremic after transplant.Results:Six hundred thirty-four patients underwent LTwith a diagnosis of HCV.There was a statistically significant trend for patients to be cured be-fore(p<0.001)and after liver transplantation(p<0.001)for the study period of 2014 to 2016 relative to 2005 and 2013,respectively.Of the 634 recipients eligible for therapy,8%and 74%were treated within 12 months of transplant for the study periods 2005 to 2013 and 2014 to 2016,respectively.There was a significant decrease between the two study periods in the proportion of patients undergoing re-LT 1 year after the original LT:5.5%(n=28/510)and 1.5%(n=2/124)respec-tively for study periods 2005 to 2013 and 2014 to 2016 respec-tively(p=0.011).Conclusions:The proportion of LTrecipients who are viremic has decreased over time.Eliminating HCV in LT recipients is feasible after the introduction of direct-acting agents.Curing HCV should translate to improved clinical out-comes in LT recipients who were transplanted for HCV infection with longer follow-up.Preliminary results suggest the de-creased need for transplant in the direct-acting agents era.