Peer-review started: August 20, 2014
First decision: October 14, 2014
Revised: October 30, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: January 27, 2015
Hepatitis C is a strong prognostic factor for patients with hepatocellular carcinoma (HCC). Although liver resection and liver transplantation offer the chance of a cure for HCC, adequate management of co-existing infection with hepatitis C virus (HCV) is important to enable better long-term outcomes after surgery for HCV-related HCC. For patients undergoing liver resection, perioperative anti-viral treatment is recommended, since a decreased HCV viral load itself is reportedly associated with a lower tumor recurrence rate and a longer overall survival. For patients undergoing transplanatations for HCC complicated by end-stage liver disease, the post-transplant management of HCV infection is also necessary to prevent progressive graft injury caused by active hepatitis under the immunosuppressive condition that is needed after liver transplantation. Although only a few lines of solid evidence are available for postoperative antiviral treatment because of the limited indication and frequent adverse events caused by conventional high-dose combination interferon therapy, new direct acting anti-viral agents would enable interferon-free anti-viral treatment with a higher virologic response and minimal side effects.
Core tip: Hepatitis C infection is associated with a poor survival outcome after curative surgical resection or liver transplantation in patients with hepatocellular carcinoma (HCC). For patients undergoing liver resection, the adequate perioperative management of hepatitis C is vital for reducing the carcinogenic potential of the liver remnant and obtaining a longer disease-free interval. For patients undergoing transplantations for HCC with end-stage liver disease, the control of hepatitis C is also needed to avoid progressive graft dysfunction because of active hepatitis under immunosuppressive condition.