Direct-Acting Agents Help to Eliminate Hepatitis C in Liver Transplant Recipients

The introduction of direct-acting agents (DAAs) has caused a significant reduction in the percentage of liver transplant recipients for hepatitis C virus (HCV) who are viremic after surgery, according to study results published in the Journal of Clinical and Translational Hepatology.¹

HCV is one of the most common reasons for liver transplantation in the United States,^2,3  and recurrent infection can lead to both patient and graft loss.^4,5 DAAs have increased cure rates and have been found to be safe, effective, and tolerable after liver transplantation.^6-8 Use of DAAs began at the University of California Los Angeles Medical Center in 2013, and therefore researchers at that institution studied the effect of DAAs on the elimination of HCV in 634 patients with HCV who underwent liver transplantation between January 2005 and June 2017.¹ 

After analyzing data on the date of transplant and the type and timing of antiviral therapy, they found that the percentage of patients who were treated within 12 months of transplant increased from 6% in 2005 to 2013 to 33% in 2014 to 2016 (P <.001). Within 2 years of liver transplant, more patients were cured of HCV in the study period from 2014 to 2016 compared with 2005 to 2013 (78% vs 18%, P <.001). The percentage of patients undergoing an additional liver transplant at 1 year after the original transplant decreased from 5.5% in 2005 to 2013 to 1.5% in 2014 to 2016 (P =.011). In addition, there was a significantly higher rate of pre-transplant HCV treatment in liver transplant recipients after 2013; prior to 2014, 5% of transplant recipients were treated before transplantation compared with 25% of recipients of transplantation after 2014 (P <.001).

Investigators concluded that “HCV can be eliminated from the liver transplant cohort in this country with treatment commencing either before or after liver transplantation.”¹ In addition, “preliminary results suggest the decreased need for transplant in the direct-acting agents era.”

References

1. Saab S, Challita Y, Chen PH, et al. Elimination of hepatitis C in liver transplant recipients. J Clin Transl Hepatol. 2018;6(3):247-250.
2. Kim WR, Lake JR, Smith JM, et al. OPTN/SRTR 2013 Annual Data Report: liver. Am J Transplant. 2015;15 Suppl 2:1-28.
3. Goldberg D, Ditah IC, Saeian K, et al. Changes in the prevalence of hepatitis C virus infection, nonalcoholic steatohepatitis, and alcoholic liver disease among patients with cirrhosis or liver failure on the waitlist for liver transplantation. Gastroenterol. 2017;152:1090–1099.e1.
4. Forman LM, Lewis JD, Berlin JA, Feldman HI, Lucey MR. The association between hepatitis C infection and survival after orthotopic liver transplantation. Gastroenterology. 2002;122:889-896.
5. Firpi RJ, Clark V, Soldevila-Pico C, et al. The natural history of hepatitis C cirrhosis after liver transplantation. Liver Transpl. 2009;15:1063-1071.
6. Saab S, Manne V, Bau S, et al. Boceprevir in liver transplant recipients. Liver Int. 2015;35:192-197.
7. Suraweera D, Sundaram V, Saab S. Treatment of hepatitis C virus infection in liver transplant recipients. Gastroenterol Hepatol. 2016;12:23-30.
8. Brown RS Jr, O’Leary JG, Reddy KR, et al. Interferon-free therapy for genotype 1 hepatitis C in liver transplant recipients: real-world experience from the hepatitis C therapeutic registry and research network. Liver Transpl. 2016;22:24-33.