Management of Hepatitis C in the Pre- and Post-Transplant Setting: Then and Now

The prevalence and accelerated course of recurrent hepatitis C infection after liver transplantation is associated with significant morbidity and mortality. Use of dual therapy with interferon/ribavirin or triple therapy with first-generation NS3/4 protease inhibitors for the treatment of hepatitis C in cirrhotic and post-transplant patients has yielded only modest sustained virologic response (SVR) rates. The advent of multiple new direct-acting antiviral agents has led to improved treatment outcomes in patients with chronic hepatitis C; all while minimizing undesired side effects and adverse reactions. This review describes the treatment of hepatitis C in cirrhotic patients awaiting transplantation and in patients with recurrent HCV after transplantation and the role of new all-oral therapy in both of these patient populations.