Early acute cellular rejection (ACR) after liver transplantation in patients with hepatitis C virus (HCV) has become less common in the direct-acting antiviral (DAA) era, with lower rejection and reduced mortality after rejection, according to a retrospective data analysis published in the Journal of Hepato-Biliary-Pancreatic Sciences.1

In the interferon (IFN) era, liver transplant (LT) recipients with HCV had worse allograft failure and death rates compared with those without HCV.2,3 However, LT-recipient survival has improved since the introduction of IFN-free treatment with DAAs, due to improved survival of those with HCV cirrhosis and HCV-related hepatocellular carcinoma.4-6 It is unknown whether DAAs affect rejection rates or post-LT survival, therefore researchers used data from the nationwide United Network for Organ Sharing registry (STAR file) as of December 2017 (n=25,916) to determine whether rejection or posttransplant outcomes have changed in the DAA era.1 They found that compared with LT recipients without HCV, LT recipients with HCV had worse survival in the IFN era (2007-2008) and IFN+DAA era (2011), but not in the DAA era (2014-2015). Acute cellular rejection within 6 months post-LT (ACR6m) was less frequent in newer eras and was lower in LT recipients with HCV than in LT recipients without HCV in both the DAA era (6.9% vs 9.3%, P <.001) and in the IFN+DAA era (8.8% vs 11.8%, P =.001), but not in the IFN era (10.8% vs 11.0%, P =.39). In addition, LT recipients with HCV who had ACR6m had worse 2-year survival than those without ACR6m in the IFN era (80.0% vs 88.4%, P <.0001) and in the IFN+DAA era (81.4% vs 89.2%, P <.01) but not in the DAA era (90.4% vs 93.2%, P =0.085).

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The authors concluded that, “Two-year survival of HCV-LT recipients were significantly better in DAA-era: these were associated with reduced rate and impact of ACR6m.”1


References
1. Tanaka T, Voigt MD. Acute cellular rejection in hepatitis C recipients following liver transplantation in the era of direct acting antivirals: chronological analysis of the United Network for Organ Sharing database[published online June 18, 2019]. J Hepatobiliary Pancreat Sci. doi:10.1002/jhbp.645

2. 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(4):889-896.

3. Campos-Varela I, Lai JC, Verna EC, et al. Hepatitis C genotype influences post-liver transplant outcomes. Transplantation. 2015;99(4):835-840.

4. 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.

5. Belli LS, Perricone G, Adam R, et al. Impact of DAAs on liver transplantation: major effects on the evolution of indications and results. An ELITA study based on the ELTR registry. J Hepatol. 2018;69(4):810-817.

6. Crespo G, Trota N, Londono MC, et al. The efficacy of direct anti-HCV drugs improves early post-liver transplant survival and induces significant changes in waiting list composition. J Hepatol. 2018;69(1):11-17.