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Chronic hepatitis C virus (HCV) infection related liver diseases are a leading indication for liver transplantation (LT) worldwide, responsible for about 20% of all LT performed in Europe and the United States. In the context of liver transplantation, treatment of HCV infection has been classically challenging because of therapies’ low efficacy and safety concerns associated with interferon-based regimens, so that patients with decompensated cirrhosis and liver graft recipients have been typically considered as “difficult to treat populations.” The arrival of the new direct-acting antiviral agents (DAAs) has transformed the management of these patients. Treating LT candidates not only prevents viral recurrence, but importantly, leads to functional improvement and potential delisting from the waiting list. Efficacy, safety, and tolerability of DAA treatments worsen as the severity of liver disease increases. In the posttransplant setting, DAA therapies now have excellent efficacy and tolerability, so much so that the transplantation of HCV positive donors into HCV negative recipients in some regions of the world is considered a viable option to increase a limited donor pool. This is especially true in North America, where the opiate epidemic has fueled an availability of viable organs for donation.

DOI: 10.1007/978-3-030-01751-4_38-1