The future of liver transplantation for viral hepatitis

Abstract

In hepatitis C virus ( HCV )- infected patients, transplantation can be justified by decompensated cirrhosis, hepatocellular carcinoma ( HCC ) or both. During the last decade, HCV infection accounted for about 30% of the indications for transplantation in Europe and North America. Direct antiviral agents ( DAA s) are highly effective at curing HCV , even in patients with end- stage cirrhosis. In the future, the incidence of HCV – related decompensated cirrhosis will continue to decrease. The incidence of HCC will also decrease, but a large cohort of patients with cirrhosis will still be at risk of developing HCC even after HCV has been cured. They will continue to represent potential candidates for transplantation. Overall, HCV will account for a significantly lower propor tion of indications for transplantation in the future. However, generalization of DAA s is unlikely to affect the total transplantation volume as the gap between donors and potential recipients markedly exceeds 30%. In addition, non- alcoholic steatohepa- titis ( NASH ) is a rapidly growing indication for transplantation. The high barrier to resistance nucleos(t)ide analogues ( NUC s) have been used for several years to treat hepatitis B virus ( HBV ) infection. Decompensated HBV cirrhosis now represents a very uncommon indication for transplantation. HCC remains the leading indication in HBV – infected patients awaiting transplantation. NUC s plus anti- HB s immune globulins or NUC s alone are highly effective at preventing post- transplant HBV recurrence. However, continuous prophylaxis is still needed as extrahepatic HBV particles persist with a potential for recurrence. Post- transplant immunosuppression facilitates recurrence. In the future, an important challenge will be to cure HBV by eliminating residual HBV particles

 
K E Y W O R D S
direct antiviral agents , hepatitis C virus , hepatocellular carcinoma , non-alcoholic steatohepatitis

About Speaker

François DURAND

France


Biography of François DURAND

Dr François Durand is head of the Hepatology Department & Liver Intensive Care Unit of Hospital Beaujon, Clichy and Professor of Hepatology at University Paris VII Diderot, Paris, France. His main topics in research and teaching have been liver transplantation, complications of end stage cirrhosis (especially in the field of intensive care) and acute liver failure. Dr François Durand is cited in 339 publications in peer review journals in Hepatology, Gastroenterology Transplantation and Intensive Care Medicine with an author h-index of 62 (source, Scopus) and 12592 citations. He has been involved in many multicenter clinical trials in the fields of immunosuppression, management of complications of cirrhosis and viral hepatitis. He has been invited speaker for academic meetings on behalf of the American Association for the Study of Liver Disease (AASLD), the European Association for the Study of the Liver (EASL), the International Liver Transplant Society (ILTS) and the European Society of Transplantation (ESOT), among others. Dr François Durand
is currently Associate Editor of the Journal of Hepatology (impact factor 10.4), member of the council of the ILTS and secretary of the International Club of Ascites. He and his colleagues have already conducted several studies and written review articles published in high quality journals on impaired renal function in cirrhosis.

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