Ask the Experts - Timing of Liver Transplantation in Patient With HCV?
I am taking care of a 40-year-old male with chronic hepatitis C virus (HCV) infection and cirrhosis, Child's class C. He has no history of encephalopathy and he is active in daily living apart from occasional fatigue. The rest of his organs are functioning normally. At this point, he is not a candidate for interferon/ribavirin treatment. Do you recommend transplantation at this point or can he wait?

Dr. Khalil

If the patient has established cirrhosis due to HCV, but has not had any features of decompensation (ascites, gastrointestinal hemorrhage, jaundice, coagulopathy, low albumin, hepatic encephalopathy), he has well-compensated cirrhosis and may not meet the minimal listing criteria for liver transplantation (Child-Pugh score of 7). However, in a patient with HCV who is not a candidate for antiviral treatment, the disease will progress and he will decompensate over time. Therefore, he can wait, but he should be closely followed by a hepatologist or gastroenterologist and seen at least every 3-6 months to monitor for signs of decompensation, at which time he should be evaluated and added to the waiting list for liver transplantation. Since the waiting time for transplantation is quite long, his evaluation and listing should be postponed until he has severe, advanced liver disease.