Liver transplantation for hepatitis C patients in the era of direct-acting antiviral treatment: A retrospective cohort study. (March 2020)

• Record Type: Journal Article
• Authors: Khan, Adeel S.; Adams, Nathaniel; Vachharajani, Neeta; Dageforde, LeighAnne; Wellen, Jason; Shenoy, Surendra; Crippin, Jeffrey S.; Doyle, Majella B.; Chapman, William C.
• Is Part Of: International journal of surgery. Volume 75(2020)
• Page Start: 84
• Page End: 90
• Publication Date: 2020-03
• Subjects: Liver transplant -- Direct-acting antiviral agents -- Hepatitis C; HCV Hepatitis C virus -- DAA Direct acting antiviral -- LT Liver transplantation -- US United States -- IFN Interferon -- CKD Chronic kidney disease -- IRB Institutional review board -- MELD Model for end stage liver disease -- CTP Child's Turcotte Pugh; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2020.01.145
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Introduction: Direct-acting antivirals (DAA's) have revolutionized hepatitis-C virus (HCV) treatment, however controversy remains regarding timing of treatment in relation to liver-transplant (LT). Methods: Single-center retrospective study assessing outcomes of listed HCV positive patients in the DAA-era (2014–2017). Patients treated with DAA's before LT (DAA pre-LT) were compared to those who were not treated before LT (No DAA pre-LT) Results: 156 HCV positive patients were listed during study-period; 104 (67%) underwent LT while 52 (33%) were de-listed. Of transplanted patients, 48 (46%) received DAA pre-LT while 56 (54%) were treated post-LT. Both groups were comparable in age, gender, MELD, patient and graft survival and cure-rates (98% in DAA pre-LTvs.95% in No DAA pre-LT; p > 0.05). DAA pre-LT group required higher number of treatments-per-patient to clear virus (1.46vs.1.06; p = 0.0006), spent more time on waitlist (331d.vs150d; p = 0.0040) and were less likely to receive livers from HCV positive donors (6%vs.25%; p = 0.0148). Twenty-nine (56%) of the 52 delisted received DAA. They had lower listing-MELD (12vs.18; p = 0.0033), and were more likely to be delisted for "condition improved" (34%vs.4%; p = 0.0143) compared to the 23 (44%) delisted patients who did not receive DAA's. Conclusions: DAA's were equally effective in clearing HCV in listed patients irrespective of timing. DAA pre-LT can disadvantage some patients through increase number of treatments needed and longer waitlist times, but treatment in some listed patients with low-MELD can improve condition and alleviate need for LT. Highlights: Direct-Acting Antiviral (DAA) treatments are effective in curing Hepatitis C (HCV) in liver transplant (LT) patients. Timing of treatment before or after LT does not affect cure rates. Waiting to treat HCV after LT can considerably reduce weight-list time. Treating patients after LT requires fewer courses of DAA. DAA treatment in select patients can alleviate the need for LT.