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HCV RNA in liver explants does not lead to HCV recurrence post-transplant

VIENNA — The presence of hepatitis C virus infection RNA in liver explants did not correlate with a likelihood of hepatitis C recurrence after liver transplantation, according to study results presented at the 2015 International Liver Congress.

“Hepatitis C recurrence is universal in patients with detectable HCV RNA at time of liver transplantation,” Martina Gambato, MD, Liver Unit, University of Barcelona, Spain, said during her presentation. “Due to the high efficacy and good safety profile of direct-acting antivirals, most patients awaiting [liver transplant] will undergo antiviral therapy. Residual HCV RNA in the liver explants has been previously shown to be associated to HCV recurrence in patients treated with [pegylated interferon and ribavirin] on the waiting list.”

Gambato and colleagues analyzed liver explant samples of 38 patients with HCV and cirrhosis that underwent liver transplantation and were compared with explants from 39 transplant recipients negative for HCV being used as controls. All patients received 3 to 52 weeks of Sovaldi (sofosbuvir, Gilead Sciences) and ribavirin while waiting for transplant. The researchers measured HCV RNA levels in the liver using quantitative real-time polymerase chain reaction (PCR).

“[We hypothesized] that in HCV-infected patients awaiting liver transplant and treated with direct-acting antivirals, the persistence of residual HCV RNA in the liver explants might be related to recurrence of infection after liver transplant,” Gambato said. “The aim was to assess the presence of HCV RNA in liver explants from patients treated with sofosbuvir and ribavirin while awaiting liver transplant and to investigate the correlation between the presence of HCV RNA in liver explants.”

Thirty patients were included in the final analysis. Among these patients, 18 liver explants were HCV RNA-positive and 11 were HCV RNA-negative. Of the patients with HCV-positive explants, 78% (n = 14) achieved virologic response at 12 weeks and 22% relapsed (n = 4). In the explants that were HCV RNA-negative 83% achieved virologic response (n = 10) and 17% did not (n = 2).

The treatment duration and time with undetectable HCV RNA before transplant was lower in patients positive for HCV RNA in liver explants compared with patients negative for HCV RNA (16 and  7 weeks vs. 24 and 13 weeks; P = .037, P = .045, respectively).

HCV RNA was detected in liver explants from 68% of responders (16/24) and in 70% of non-responders (7/10; P = .850).

“More than 50% of patients treated on the liver transplant waiting list with sofosbuvir and ribavirin were HCV RNA-positive in liver explants,” Gambato said. “The presence of HCV RNA in liver explants did not significantly correlate with the likelihood of recurrent HCV infection post-transplant. Considering patients with HCV RNA-positive explant, relapse after liver transplant occurred in those with higher HCV RNA concentration in the explant compared to responders.” – by Melinda Stevens

For More Information:

Gambato M. Abstract O108. Presented at: International Liver Congress; April 22-26, 2015; Vienna.

Disclosure: The researchers report no relevant financial disclosures.