Hepatitis C virus (HCV) is a major cause of death from infectious disease and is still the leading indication for liver transplantation in the United States and other Western countries. All-oral, direct-acting antiviral (DAA) therapies have revolutionized the field, with HCV cure rates of more than 90% among treated patients. The safety and tolerability of these DAA agents have expanded the feasibility of HCV treatment even in the challenging pre- and post-liver transplant settings. However, the unique properties of DAA agents and the host profiles in these settings can limit the generalizability of HCV regimens, and prolongation of treatment duration or addition of ribavirin may be required in certain scenarios to optimize treatment outcomes. HCV therapy in the liver transplant setting is not one-size-fits-all; thus, this review summarizes the published data and emphasizes the applicability of currently available DAA therapies in patients with decompensated cirrhosis and in liver transplant recipients.
Keywords: Hepatitis C virus; direct-acting antiviral agents; fibrosing cholestatic hepatitis; liver transplantation.