Although oral antiviral agents have improved liver function in patients with hepatitis C virus (HCV) infection, the relationship between their use and outcomes for patients on liver transplant waiting lists or for those who underwent liver transplant has been unconfirmed.
In a recent study published in the Journal of Hepatology, researchers found that pre-liver transplant treatment with these drugs decreased the number of patients on liver transplant waiting lists and improved post-transplant outcomes.
The study compared the populations of liver transplant-waitlisted patients in Catalonia, Spain, before (2008-2013) and after (2014-2016) the introduction of oral antiviral agents as part of waitlist protocol for patients with HCV.
Although the oral antiviral regimens were not the same for all patients in the 2014-2016 cohort, significant results were found in terms of both waitlist composition and transplant survivability.
In terms of waitlist reduction, the researchers found that among patients treated with the protocol during the study period, “intention-to-treat (ITT) [sustained virologic response at 12 weeks] was 91% (107/118). ITT SVR12 was 95% (71/75) in patients with [hepatocellular carcinoma] as the indication of liver transplant and 84% (36/43) in patients with decompensated cirrhosis (P =.05).” Furthermore, 13% of patients with cirrhosis were able to be delisted due to improvement in liver function following treatment (P =.05) compared with only 4% in the comparison group (P =.02).
In terms of post-transplant survivability, the overall rates of survival increased during the study period (82% vs 91%, P =.002). Through multivariate regression analysis, the researchers were able to determine that this increase was due to improved survival among anti-HCV-positive patients treated with oral antivirals; survival was not statistically significantly improved in anti-HCV-negative patients (88% vs 91%; P =.359).
Indeed, researchers found that “the improvement in survival was driven solely by anti-HCV positive patients… as there were no differences in survival between the two eras in anti-HCV negative patients.” Specifically, although anti-HCV-negative patients had a significantly better chance of survival following liver transplant before antiviral treatment usage became common (P <.001), “there was no difference in post-liver transplant survival according to HCV serostatus in the period 2014-2016 (P =.645).”
These results indicate that treatment of HCV with oral direct-acting antiviral agents can improve transplant access and survival following transplantation, and should therefore be considered for inclusion in the standard of care.
Crespo G, Trota N, Londoño M-C, et al. The efficacy of direct anti-HCV drugs improves early post-liver transplant survival and induces significant changes in wait-list composition. [published online February 23, 2018]. J Hepatol. doi: 10.1016/j.jhep.2018.02.012