Hepatitis C and liver transplantation in direct acting antiviral era

Chronic hepatitis C virus (HCV) infection remains a principle causative factor for cirrhosis, hepatocellular carcinoma (HCC) and liver transplantation world-wide. The inevitable HCV recurrence of the engrafted liver was associated with the worst post-liver transplant survival outcome as compared to other etiologies in the interferon era. The inception of direct acting antiviral agents (DAAs) has changed the paradigm of HCV management in the liver transplant setting. These highly effective agents can cure HCV infection even in advanced cirrhosis with adequate safety. The future appears promising for HCV with expected decline in hepatic decompensation and incidence of HCC, but a significant proportion of patient with cirrhosis will remain at risk for HCC despite HCV cure. Use of DAAs has not affected the global transplant activity due persistent gap between the donors and the potential recipients. Curing HCV may improve the liver transplant outcome by controlling the co-morbidities like diabetes and chronic kidney disease in patients transplanted for HCV.