Treatment strategies for patients with decompensated liver cirrhosis due to HCV infection – Antiviral treatment or liver transplantation first?

Since the availability of oral direct acting antivirals (DAA) chronic hepatitis C virus infection can be treated effectively in almost all patients. However, treatment of patients with decompensated cirrhosis remains difficult since clinical deterioration and the need for transplantation despite prior antiviral treatment have been reported. On the other hand antiviral treatment after transplantation leads to viral eradication with high certainty. Whether initiation of antiviral treatment in patients with decompensated cirrhosis and high MELD scores should be preferred to liver transplantation as a curative treatment strategy remains unclear. Therefore we analyzed treatment strategies of German liver transplantation centers retrospectively since introduction of DAA in August 2014 to compare clinical outcome based on treatment strategy (DAA vs. transplantation) for patients with high MELD scores.