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HCV-based liver transplant survival jumps in early DAA era

In a short-term analysis, researchers found that survival rates improved among patients who underwent liver transplant for chronic hepatitis C after direct-acting antiviral approvals.

“In the past, pre-emptive treatment of recurrent HCV infection in LT recipients with interferon-based regimens was not pragmatic due to suboptimal sustained virological response (SVR) rates and poor adverse effects profile,” George Cholankeril, MD, from Stanford University School of Medicine, and colleagues wrote. “In contrast, the second generation direct-acting antiviral (DAA) agents are highly efficacious and well-tolerated by HCV-infected LT recipients.”

The researchers reviewed the outcomes of liver transplant for chronic HCV as reported in the United Network for Organ Sharing database from 2011 to 2012 – the pre-DAA era – and from the DAA era of 2014 to 2015. They excluded 2013 as a 1-year overlap of follow-up. The study comprised 3,672 patients from the pre-DAA era and 3,855 from the DAA era and excluded patients with hepatocellular carcinoma.

Both 1-year posttransplant survival and graft survival were significantly higher among patients from the DAA era (91.9% vs. 89.9%; P < .001). Further, researchers observed an association between the DAA era and a 34% reduction in 1-year posttransplant mortality (HR = 0.66; 95% CI, 0.6-0.72).

The data showed no significant difference in either 1-year patient or graft survival between eras among non-HCV liver transplant patients.

Compared with patients undergoing liver transplant for HCV, patients who underwent liver transplant for non-HCV indications in 2011 (91.2% vs. 88.6%; P < .001) and 2012 (92.5% vs. 89.4%; P < .001) had greater 1-year survival, whereas after 2013 there was no significant difference in the rates.

“The reduction in HCV-related post-LT mortality and graft failure may be a result of efficacious peri-transplant therapeutic options available to prevent and treat complications including fibrosing cholestatic hepatitis (FCH). FCH is noted in up to 10% of HCV LT recipients presenting as rapidly progressive cholestatic liver disease leading to rapid graft loss and increased mortality,” the researchers wrote. “DAA-based regimens have proven to be effective in preventing post-LT complications of recurrent HCV infection.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.