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Abstract：
Treatment of hepatitis C virus (HCV) with newer directly acting antivirals (DAAs) and lead to sustained viral response (SVR) in majority of patients and SVR has been documented to be associated with reversal of liver cirrhosis. The improved SVR rates and safety profiles of DAAs have led to the treatment of patients with decompensated cirrhosis awaiting liver transplantation (LT). Several clinical trials of DAAs in decompensated HCV patients have recently demonstrated SVR rates above 80%, which have been associated with significant improvements, in the Child-Pugh-Turcotte scores/or model for end-stage liver disease scores in a proportion of patients. Moreover, it has been shown that HCV RNA becomes negative after 2-4 weeks of treatment, and those who are transplanted after becoming HCV RNA negative will be have very low the risk of HCV recurrence after transplantation. Some of the patients may have reached the \"point of no return\" and may proceed to worsening of decomposition over time. To avoid the risk of worsening, there is an additional option of treating these patients after LT should they develop recurrent HCV infection. Currently there are no guidelines as to select patients who would benefit from treatment prior to LT as opposed to those who will be better off being treated after the transplant surgery. The article discusses a possible approach for such selection.
摘要：
用较新的直接作用抗病毒药物（DAA）治疗丙型肝炎病毒（HCV），并在大多数患者中导致持续的病毒反应（SVR），并且SVR已被证明与肝硬化的逆转有关。DAA改善的SVR率和安全性已导致等待肝移植（LT）的失代偿性肝硬化患者的治疗。DAA在失代偿性HCV患者中的一些临床试验最近证明SVR率超过80％，这些都有显著的改进，Child-Pugh-Turcotte评分/或部分患者终末期肝病评分模型。此外，研究表明，HCVRNA在治疗2-4周后变为阴性，而那些在HCVRNA阴性后移植的人在移植后HCV复发的风险将非常低。一些患者可能已经达到“不归点”，并可能随着时间的推移而继续恶化分解。为了避免恶化的风险，如果这些患者发展为复发性HCV感染,则在LT后还有另外一种治疗选择.目前，没有指南来选择在LT之前从治疗中受益的患者，而不是在移植手术后更好地治疗的患者。本文讨论了这种选择的可能方法。
