In some patients, hepatitis C best treated after transplant

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Direct-acting antiviral drugs can eradicate the hepatitis C virus, even in patients with advanced liver decompensation. But their outcomes may be better if treatment occurs after transplant, according to a recent study looking at this issue.

The goal of the study was to determine when life expectancy was improved with DAA treatment, before or after liver transplant. One reason these may differ is that the trade-off for improved liver function with early treatment is the risk for delay—or even delisting for transplant—as a result of that improvement. In the “virtual trial,” the specific threshold score on the Model for End-Stage Liver Disease (MELD) associated with a benefit from delayed antiviral therapy ranged according to waitlist time for a donor organ.

“Patients above the threshold may be better off to wait until after transplant to receive DAA therapy,” said Jagpreet Chhatwal, PhD, who holds appointments in the Institute for Technology Assessment and the Liver Center at Massachusetts General Hospital, in Boston.

Dr. Chhatwal presented his data at the 2016 annual meeting of the American Society for the Study of Liver Diseases (abstract 254). The full manuscript has since been published in Hepatology (2017;65:777-788)

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Corey Bryant serves as Director of Communications for The Alliance.
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