DAA Therapy Outcomes in HCV-Infected Transplant Candidates After Organ Delisting

Hepatitis C virus (HCV) antiviral therapy in liver transplant candidates with decompensated cirrhosis may result in long-term improvement in liver function, giving as many as 1 in 3 patients the possibility of being taken off the transplant list, according to a study published in Liver International.¹

Many people infected with HCV who have decompensated cirrhosis are on the waiting list for liver transplantation. A previous study by the European Liver and Intestine Transplant Association, however, showed that treatment with second-generation direct-acting antivirals (DAAs) resulted in nearly 25% of patients being taken off the transplant list because of clinical improvement.^1-4

The long-term risk for de-novo decompensation and hepatocellular carcinoma (HCC) after being removed from the transplant list was not assessed, and therefore researchers in Europe decided to address the possible clinical complications that occurred after removal from the list for a median follow-up of nearly 2 years.¹

In this study, 142 people who were positive for HCV and had decompensated cirrhosis and were negative for HCC but were on the liver transplant waiting list were treated with DAA therapy and followed prospectively.

Of these patients, 44 (30.9%) were taken off the transplant list following clinical improvement. Three patients were put back on the list because of recurrent grade 3 ascites. These patients were continuing to take a low dose of a diuretic medication, which is a possible risk factor for subsequent relisting.

In addition, 1 patient was put back on the transplant list as a result of an HCC diagnosis, and 1 patient died of rapidly progressing HCC 22 months after being taken off the transplant list. 

Therefore, the risk for re-decompensation or for development of HCC in people who were removed from the transplant list was less than 10%.  

“In conclusion, this study demonstrates that DAA therapy in liver transplant candidates with decompensated cirrhosis is effective and results in long-term improvement in liver function, giving one in three patients the possibility to delist with low risk for future liver related complications,” stated the authors.¹

References

1. Perricone G, Duvoux C, Berenguer M, et al, European Liver and Intestine Transplant Association (ELITA). Delisting HCV-infected liver transplant candidates who improved after viral eradication: outcome 2 years after delisting [published online May 11, 2018]. Liver Int. doi: 10.1111/liv.13878

2. Belli LS, Berenguer M, Cortesi PA, et al. Delisting of liver transplant candidates with chronic hepatitis C after viral eradication: a European study. J Hepatol. 2016;65(3):524-531.

3. Coilly A, Pageaux G-P, Houssel-Debry P, et al. Improving liver function and delisting of patients awaiting liver transplantation for HCV cirrhosis: do we ask too much to DAAs? Presented at: 66th Annual Meeting of the American Association for the Study of Liver Diseases; November 13-17, 2015; San Francisco, CA. Abstract 95.

4. Pascasio JM, Vinaixa C, Ferrer MT, et al. Clinical outcomes of patients undergoing antiviral therapy while awaiting liver transplantation. J Hepatol. 2017;67(6):1168-1176.