Hepatitis C is the number one disease leading to cirrhosis and liver failure that requires liver transplantation.  In the past, patients that underwent a liver transplant for hepatitis C were immediately re-infected with the hepatitis C virus.  In a number of cases, the reinfection with the hepatitis C virus caused problems related to the transplanted liver.  Following successful liver transplant, a subset of patients developed very aggressive reinfection of the liver, leading to a potentially fatal complication called fibrosing cholestatic hepatitis.  In many cases, this would lead to severe malfunctioning of the transplanted liver, with an unacceptably high mortality rate.  A number of patients that were transplanted for hepatitis C would experience very mild problems related to the hepatitis C, though a good number of patients following transplant would develop progressive damage to the liver over one to three years following transplant.

In years past, the available antiviral therapies for hepatitis C were toxic, and had a number of drug interactions making it very difficult to treat the post-liver transplant patients.  The good news now is that with the widely available direct-acting antiviral agents, without the need for interferon, we are now able to aggressively treat patients both before liver transplant, in the cirrhotic stage, as well as immediately post-liver transplant with a very high cure rate in these patients.  These are successes we were unable to experience prior to this.

The standard approach that we have is to evaluate each patient with cirrhosis, including those with advanced cirrhosis and its complications.  We will carefully explain to the patient the pros and cons of being treated before liver transplant, with the hope that we can cure the patient of their hepatitis C before successful liver transplant.  It would be very beneficial to go into the transplant surgery virus free, essentially eliminating the chance that they will develop recurrent hepatitis C after liver transplant.

In situations where we are unable to treat the patient before transplant, based on their underlying medical conditions or availability of the medicines per their insurance company, we will immediately initiate antiviral therapy following transplant in the first four to eight weeks after liver transplant surgery.  Over the past 18 months, we have had excellent responses and have cured many patients of their hepatitis C post-liver transplant.

New therapies continue to be approved through 2015, and in 2016, we expect additional combinations of new HCV drugs to be FDA approved.

Call our office at 713-794-0700 for an appointment and clinical evaluation.