Graft Survival After Liver Transplantation for Patients With HCV on Direct-Acting Antivirals

liver transplant
liver transplant
Despite being in the age range of their mid-fifties, patients with hepatitis C who have undergone liver transplants in a time period when direct-acting antivirals are available have fared similarly to liver transplant recipients without hepatitis C.

While the number of liver transplants for hepatitis C virus (HCV) in the United States has decreased by more than one-third over the past decade, graft survival in HCV-positive recipients has increased and these patients are achieving similar outcomes as recipients without HCV, according to study results published in Liver Transplantation.1

With the approval of direct-acting antiviral (DAA) therapy, not only has treatment improved for HCV, but HCV is no longer the most common indication for liver transplantation in the United States.2-6 Patients who are HCV-positive and undergo liver transplantation often experience universal recurrence: However, recent studies have indicated that patients treated in the DAA era may have better short-term graft survival compared with those treated in the pre-DAA era.7,8 Few data are available on longer-term outcomes in recipients who are HCV-positive in the DAA era; therefore researchers analyzed the Scientific Registry of Transplant Recipients for 52,526 liver transplant recipients in the United States from January 1, 2008 to June 30, 2018 and compared graft loss in liver transplant recipients who were HCV-positive with liver transplant recipients who were HCV-negative.1 They found that the number of liver transplants decreased from 2008 to 2017, with a substantial decline occurring, since 2015. Graft survival improved for all recipients in the DAA era, but most dramatically in recipients who were HCV-positive.

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The investigators concluded that, “in the DAA era, HCV-positive recipients had substantially better graft survival than HCV-positive recipients in the pre-DAA era, with graft survival now comparable to [what is] observed in non-HCV recipients.”1 They added that, “recipients without HCV infection in the DAA era also experienced improved graft survival compared to the pre-DAA era, suggesting that the observed improvements were not solely on the basis of the impact of DAAs.”


1. Cotter TG, Paul S, Sandıkçı B, et al. Improved graft survival after liver transplantation for recipients with hepatitis C in the direct-acting antiviral era [published online February 4, 2019]. Liver Transpl. doi: 10.1002/lt.25424

2. Afdhal N, Zeuzem S, Kwo P, et al. Ledipasvir and sofosbuvir for untreated HCV genotype 1 infection. N Engl J Med 2014;370:1889-1898.

3. Afdhal N, Reddy KR, Nelson DR, et al. Ledipasvir and sofosbuvir for previously treated HCV genotype 1 infection. N Engl J Med 2014;370:1483-1493.

4. Forns X, Lee SS, Valdes J, et al. Glecaprevir plus pibrentasvir for chronic hepatitis C virus genotype 1, 2, 4, 5, or 6 infection in adults with compensated cirrhosis (EXPEDITION-1): a single-arm, open-label, multicentre phase 3 trial. Lancet Infect Dis 2017;17:1062-1068.

5. Gane E, Lawitz E, Pugatch D, et al. Glecaprevir and Pibrentasvir in patients with HCV and severe renal impairment. N Engl J Med 2017;377:1448-1455.

6. Kim WR, Lake JR, Smith JM, et al. OPTN/SRTR 2016 annual data report: liver. Am J Transplant 2018;18 Suppl 1:172-253.

7. Axelrod DA, Schnitzler MA, Alhamad T, et al. The impact of direct-acting antiviral agents on liver and kidney transplant costs and outcomes. Am J Transplant. 2018;18(10):2473-2482.

8. Cholankeril G, Li AA, March KL, et al. Improved outcomes in HCV patients following liver transplantation during the era of direct-acting antiviral agents. Clin Gastroenterol Hepatol 2018;16:452-453.