The Changing Landscape of Liver Transplantation
Prevention & Treatment With the development of new cures, hepatitis C virus (HCV) may move down on the list of diseases that can necessitate liver transplantation.
Currently, the main liver diseases that eventually necessitate liver transplant are HCV infection, alcoholic liver disease and non-alcoholic fatty liver disease (NAFLD). However, the FDA recently approved safe, effective antiviral medications for HCV that cure more than 90 percent of patients. As they are cured, these patients may no longer require liver transplantation, and more organs will be available for patients with other liver diseases.
This change won’t happen overnight; in fact, it will likely take 10-15 years to occur. For HCV patients who already have advanced liver disease, the antiviral medications may not be able to reverse the disease enough to avoid transplantation. Researchers must also determine whether these antivirals can prevent HCV from infecting the new liver.
"Rates of liver cancer in patients with liver disease are also rapidly rising, and in some centers is becoming the most common reason for transplantation."
Currently, thousands of patients with HCV are receiving treatment. However, these medications are expensive (approximately $100,000 for a treatment course) and patients without insurance or with limited insurance may not have approval or access to therapy. Hopefully, as more drug companies develop antiviral treatments, competition will drive the cost down and give more patients access to these cures.
Meeting the threat
Eventually, NAFLD will likely take over as the leading reason for liver transplantation. This condition is highly linked to rising rates of obesity and diabetes in the U.S. and around the world. The rates of liver cancer in patients with liver disease are also rapidly rising; in some centers, liver cancer is becoming the most common reason for transplantation.
No matter the reason for requiring transplantation, patients with the most severe liver disease receive priority listing. Disease severity is determined by calculating a score for each patient after looking at various blood test results. Recently, national attention has focused on the fact that the wait for a deceased donor liver differs by region across the U.S.
These geographic disparities in access to liver transplantation have initiated a serious debate in our field. National committees are working on solutions to create the most fair liver allocation system possible. Some ideas include establishing larger regions where organs can be shared across more states, or creating stricter rules to truly ensure that the sickest patients are prioritized.