People with chronic hepatitis C generally receive transplants if their life expectancy is clearly reduced due to liver dysfunction – and if a suitable donor organ is available. In Europe, organs are allocated according to need: whoever is at the greatest risk of dying will receive the next organ which becomes available.

However, since the introduction of interferon-free treatment with direct-acting antivirals, there is some evidence that the number of people who need a liver transplant due to hepatitis C is beginning to fall. In the majority of people with cirrhosis, curing hepatitis C is likely to stop the progression of liver disease and greatly reduce the likelihood that a liver transplant will be needed in the future.

In people with the most advanced form of cirrhosis (decompensated cirrhosis), curing hepatitis C may still leave a person with a liver that is functioning very poorly. In this case a liver transplant will still be needed.

In some people with advanced cirrhosis, either hepatitis C is not cured prior to a liver transplant or it is not possible to provide treatment for hepatitis C prior to a liver transplant. Chronic hepatitis C infection cannot be cured by liver-transplant alone. Without direct-acting antiviral treatment the donor organ becomes reinfected within just a few hours. The disease may take a more aggressive course after the transplant. Liver disease advances more quickly in liver-transplant patients who have a high viral load. This is in contrast to patients who have not had a transplant, in whom viral load does not predict disease progression.¹ A third of liver-transplant patients develop cirrhosis again within five years if hepatitis C is not cured.²

Liver-transplant patients with chronic hepatitis C can be treated with direct-acting antivirals to clear hepatitis C infection after a liver transplant. Early studies have shown very high cure rates (above 90%) in people treated with direct-acting antivirals after liver transplant. It is not essential to treat hepatitis C immediately after transplantation and in most cases doctors will monitor the progress of liver damage and wait for a person to recover from a transplant before suggesting hepatitis C treatment.