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ELITA consensus statements on the use of DAAs in liver transplant candidates and recipients

    Coordinators:
  • Author Footnotes
    † These authors contributed equally as co-ordinators and joint first authors.
    Luca S. Belli
    Correspondence
    Corresponding author. Address: Ospedale Niguarda, Epatologia e Gastroenterologia, Piazza Ospedale Maggiore 3, Milano 20162, Italy. Tel.: +39 3283627044.
    Footnotes
    † These authors contributed equally as co-ordinators and joint first authors.
    Affiliations
    Department of Hepatology and Gastroenterology, Niguarda Hospital, Italy

    International Centre for Digestive Health, School of Medicine and Surgery, University of Milano Bicocca, Italy
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  • Author Footnotes
    † These authors contributed equally as co-ordinators and joint first authors.
    Christophe Duvoux
    Footnotes
    † These authors contributed equally as co-ordinators and joint first authors.
    Affiliations
    Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est University, Creteil, France
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  • Panel of experts (in alphabetical order):
  • Author Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Marina Berenguer
    Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Affiliations
    Hepatology& Liver Transplantation Unit, Hospital Universitari I Politècnic La Fe, University of Valencia & Ciberhed, Valencia, Spain
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  • Author Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Thomas Berg
    Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Affiliations
    Section of Hepatology, Clinic for Gastroenterology and Rheumatology, University Clinic Leipzig, Germany
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  • Author Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Audrey Coilly
    Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Affiliations
    Centre Hepato-Biliaire,Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, Villejuif, France
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  • Author Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Isabelle Colle
    Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Affiliations
    Hepatology and Gastroenterology, Unversity of Gent, Belgium
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  • Author Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Stefano Fagiuoli
    Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Affiliations
    Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
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  • Author Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Saye Khoo
    Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Affiliations
    Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool
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  • Author Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Georges Philippe Pageaux
    Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Affiliations
    Department of Hepatology, Gastroenterology, and Liver Transplantation, Centre Hospitalier Universitaire, Saint Eloi, Montpellier, France
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  • Author Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Massimo Puoti
    Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Affiliations
    Department of Infective Diseases. Niguarda Hospital, Milan, Italy
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  • Author Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Didier Samuel
    Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Affiliations
    Centre Hepato-Biliaire,Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, Villejuif, France
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  • Author Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Mario Strazzabosco
    Footnotes
    ‡ These authors acted as expert contributors to the manuscript.
    Affiliations
    International Centre for Digestive Health, School of Medicine and Surgery, University of Milano Bicocca, Italy

    Yale University Liver Center, Department of Medicine New Haven, USA
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  • Author Footnotes
    † These authors contributed equally as co-ordinators and joint first authors.
    ‡ These authors acted as expert contributors to the manuscript.
Published:March 18, 2017DOI:https://doi.org/10.1016/j.jhep.2017.03.006

      Summary

      The advent of safe and highly effective direct-acting antiviral agents (DAAs) has had huge implications for the hepatitis C virus (HCV) transplant field, and changed our management of both patients on the waiting list and those with HCV graft re-infection after liver transplantation (LT). When treating HCV infection before LT, HCV re-infection of the graft can be prevented in nearly all patients. In addition, some candidates show a remarkable clinical improvement and may be delisted.
      Alternatively, HCV infection can be treated post-LT either soon after the transplant, taking advantage of the removal of the infected native liver, or at the time of disease recurrence, as was carried out in the past. In either case, some DAAs have a limited use because of their drug to drug interactions with various immunosuppressants as well as the many other drugs liver transplant recipients are often prescribed. In addition, some DAAs should be avoided in case of severe renal failure, which is not an unusual complication after LT.
      The present document provides a series of consensus statements on the LT issues that have not been extensively addressed previously. These statements have been developed to support physicians and other stakeholders in charge of LT candidates and recipients when deciding to treat HCV, especially in difficult situations.

      Keywords

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