Assessment and Management of the Patient with Hepatitis C

This chapter provides a practical approach to the assessment and management of patients with hepatitis C prior to liver transplantation. All potential liver transplant recipients should be screened for hepatitis C virus (HCV) infection with hepatitis C antibody, and active infection confirmed by measurement of HCV RNA for those testing antibody positive. Direct-acting antiviral therapies have been shown to be effective, safe, tolerable, and easy to use in the treatment of patients with compensated and decompensated liver cirrhosis. Treatment decisions informed by the pre-therapeutic assessment should be made on a case-by-case basis through multidisciplinary team discussion. The waiting time for liver transplantation remains unpredictable and there is a risk that patients commencing treatment while on the transplant waiting list remain HCV viremic at the time of transplantation. Most liver transplant programs consider the use of HCV-positive donors for HCV-positive liver recipients.