Extrahepatic Effects of HCV Eradication With DAAs in Liver Transplant Recipients

Direct antiviral agents (DAAs) are safe and effective for eradicating recurrent hepatitis C virus (HCV) infection following liver transplantation and can reverse the hypolipidemic effect of chronic HCV infection and improve glucose and renal functioning, according to a retrospective study published in Liver Transplantation.

To evaluate the impact of HCV eradication on metabolic factors in liver transplant recipients, researchers evaluated 91 liver transplant recipients with recurrent HCV infection who received interferon-free DAA treatment. These patients included 29 who were treatment naive and 62 in whom interferon-based treatment had failed. Overall, 87 (96%) patients achieved a sustained viral response at 24 weeks with eradication of recurrent HCV infection associated with a 38% and 22% reduction from baseline in diabetes and hypertension, respectively.

Specifically, at 24 weeks posttreatment, the estimated glomerular filtration rate increased from 64.9 ± 20 mL/min to 69.6 ± 20 mL/min (P =.0004). At 41 weeks posttreatment, total cholesterol levels increased from 3.8 ± 0.9 mmol/L to 4.9 ± 0.9 mmol/L (P <.0001) as a result of a significant increase in serum low-density lipoprotein levels. At 44 weeks posttreatment, hemoglobin A1c levels decreased from a mean of 35.5 ± 4.3 mmol/mol to 33.3 ± 3.6 mmol/mol. In addition, the researchers found that changes in glucose functioning, lipid profile, and estimated glomerular filtration rate were independent of weight changes and immunosuppression dosage and trough levels.

“In conclusion, increased access to highly effective DAA therapy both before and after liver transplantation should rapidly eradicate recurrent HCV infection in liver transplant recipients. In addition to preventing recurrent cirrhosis and HCV-related graft failure, HCV eradication should help improve the post-transplant metabolic profile, thereby preventing extrahepatic morbidity and mortality related to cardiovascular and renal disease,” the authors stated. However, they also suggested that larger prospective studies should be conducted to validate these extrahepatic effects of DAA therapy.

Reference

Junaid Beig J, Orr D, Harrison B, Gane E. HCV eradication with new IFN free treatment improves metabolic profile in HCV‐related liver transplant recipients [published online March 25, 2018]. Liver Transpl. doi: 10.1002/lt.25060