A large number of individuals in our community were infected with HIV and/or hepatitis C because of tainted blood. Many have passed away, while many others continue to live with the viruses and their consequences, including liver disease.
In recent year, with the introduction of Direct-acting antivirals (DAA) and their nearly universal availability across Canada, many people have now been cured of Hepatitis C given the near 100% cure rates that these new product offer. People successfully treated for hepatitis are less likely to need liver transplants and less likely to die while on a transplant waiting list, according to studies. Successful hepatitis C treatment can slow or halt liver disease progression. Among patients receiving HCV direct-acting antivirals (DAAs), achievement of sustained virologic response (SVR) is linked to a 72% reduced risk for hepatocellular carcinoma (HCC).
The rate of liver transplant wait-listing for HCV complicated by decompensated cirrhosis has decreased by over 30% in the era of DAA therapy. Further reductions in wait-listing are anticipated with increased testing, linkage to care, and access to DAA therapy.
The prospect of liver function improvement after successful hepatitis C treatment raises the possibility that effective DAA therapy could reduce patients’ MELD scores enough to lower their priority or make them ineligible for a liver transplant, but not enough so that they no longer need one – a situation that has been dubbed ‘MELD purgatory’.
For those still needing a liver transplant, availability of organs is still an issue but the situation is improving. People undergoing a liver transplant can be treated to help insure the new liver does not get infected. Treatment can be administered pre-liver transplant, post-liver transplant preemptively prior to HCV recurrence, or post-liver transplant after HCV recurrence. Furthermore, access to liver transplants in Canada for people infected with HIV is no longer an obstacle as it was a decade ago.
There has also been good progress in the use of Hepatitis C-Positive donor livers in liver transplantation.
Below are some articles related to the topics discussed above.