Hepatitis C And Liver Transplant

In a few cases, HCV leads to liver cancer or severe damage to the liver thereby leading to end of a stage in liver disease and finally failure of the liver. The only treatment that will then be effective is a transplant of the liver. Complications arising out of HCV are a very common reason for transplant of liver in adults.

The first human liver transplant was attempted in 1963 at Colorado though a successful attempt could be made only four years later. The rate of survival has been increasing steadily with better medication to prevent rejection. It is a complex surgery and follow up is a lifelong procedure. Recipients are able to get back to normal work soon after the transplant.

Evaluation
Even though you may not need a transplant, you may still be asked to go for an evaluation. There are many reasons why you may be disqualified for a transplant and some of them are:

  • Active alcohol or substance abuse
  • Metastatic cancer or other septic infections
  • Other advanced heart, lung or kidney disease, other terminal conditions

Other factors also influencing are

  • Morbid obesity
  • Not able to follow medical instructions
  • Lack of support post surgery
  • Advanced age
  • Smoking

If you are eligible, you will be put on the waiting list. The sicker a person is the higher he / she will be on the waiting list. Availability of a matching donor, your blood group etc decides the waiting period.

MELD Score
The severity of your liver disease decides your position on the transplant list. MELD means Model for End Stage Liver Disease and it is used to evaluate the advanced stage of liver disease in adults. The score is between 6-40; six being the least sick.

Transplant for Hepatocellular Carcinoma
Some patients with cirrhosis develop HCC and need a liver transplant. This is more so in people with active Hepatitis C and also in those who have been cured of HCV even after having cirrhosis. Transplant is likely to be successful if done in the beginning stage of cancer. Selection of candidate for transplant depends on the number of lesions and its sizes, whether cancer has spread beyond the liver etc

Living donor liver transplant

Majority of the liver transplants are donors who are deceased. Since the liver has an ability to regenerate, there is an option to transplant a part of the liver from a living donor. The blood type must be compatible. The donor liver is removed up to 40-60% and within weeks both the donor’s and the recipient’s livers completely regenerate.

Advantages of living donor transplant:

  • Better survival of the transplanted liver
  • Lower rejection rate
  • Recipient spends less time on the waiting list

liver-transplant

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AASLD HCV Treatment Recommendations* for Post-Liver Transplant HCV Recurrence


Recommended

Alternative


Genotype 1

treatment-naive and -experienced, including compensated cirrhosis

  • Daklinza + Sovaldi + low initial dose of ribavirin for 12 weeks
  • Daklinza + Sovaldi for 24 weeks (treatment-naive or ribavirin-intolerant)
    Harvoni + ribavirin for 12 weeks
  • Harvoni + ribavirin for 24 weeks (treatment-naive or ribavirin-intolerant)
  • Olysio + Sovaldi with/without ribavirin for 12 weeks
    Viekira Pak + ribavirin for 24 weeks if early stage fibrosis (Metavir stage F0-F2)

Genotype 1
treatment-naive and -experienced, decompensated cirrhosis

  • Harvoni + low initial dose of ribavirin for 12 weeks

n/a


Genotype 2
treatment-naive and -experienced,

including compensated cirrhosis

  • Daklinza + Sovaldi + low initial dose of ribavirin for 12 weeks
  • Daklinza + Sovaldi for 24 weeks (ribavirin-intolerant)
  • Sovaldi + ribavirin for 24 weeks

n/a


Genotype 2
treatment-naive and -experienced,
including decompensated cirrhosis

Sovaldi + low initial dose of ribavirin for 24 weeks

n/a


Genotype 3
treatment-naive and -experienced, including compensated cirrhosis

  • Daklinza + Sovaldi + low initial dose of ribavirin for 12 weeks
  • Daklinza + Sovaldi for 24 weeks (ribavirin-intolerant)

n/a


Genotype 3
treatment-naive and -experienced,
decompensated cirrhosis

  • Sovaldi + low initial dose of ribavirin for 24 weeks

n/a


Genotype 4
treatment-naive and -experienced,
including compensated cirrhosis

  • Daklinza + Sovaldi + low initial dose of ribavirin for 12 weeks
  • Daklinza + Sovaldi for 24 weeks (treatment-naive or ribavirin-intolerant)
    Harvoni + ribavirin for 12 weeks
  • Harvoni + ribavirin for 24 weeks (treatment-naive or ribavirin-intolerant)

n/a


Genotype 4
treatment-naive and -experienced,
including decompensated cirrhosis

Harvoni + low initial dose of ribavirin for 12 weeks

n/a


Genotype 5

n/a

n/a


Genotype 6

n/a

n/a


* When more than one treatment is recommended, medications are listed alphabetically

Medications that are NOT recommended for post-transplant individuals, including those with compensated cirrhosis:

  • Regimens containing peginterferon
  • Monotherapy with peginterferon, ribavirin or a direct-acting antiviral
  • Regimens using Incivek, Victrelis, or Zepatier

Medications that are NOT recommended for post-transplant individuals with decompensated cirrhosis:

  • Regimens containing Incivek, Olysio, Incivek, peginterferon, Technivie, Victrelis, Viekira Pak, or Zepatier
  • Monotherapy with peginterferon, ribavirin or a direct-acting antiviral

Organ rejection
After the transplant, a patient compulsorily needs to receive immunotherapy in order to prevent the body from rejecting the liver. There is a chance that the immune system may try to reject this new foreign body. Mostly rejection happens within a week or two after the transplant, but may occur any time. Signs of rejection include elevated levels of enzymes of the liver, fatigue, loss of appetite, pain, fever, tenderness etc


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Call 928-328-8909 to get helpful information, a Hep C guide, and facts about managing Hep C.

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