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DAA therapy improves HCV-related liver transplantation outcomes

The high efficacy of direct-acting antivirals correlated with significant improvement in survival of patients who underwent liver transplantation for hepatitis C-related liver disease, according to a recently published study.

“Hepatitis C virus (HCV) infection is the main cause of end-stage liver disease leading to liver transplantation (LT) in the Western world, and until the widespread use of the direct-acting antiviral regimens (DAA) it had a significant detrimental impact on posttransplant patient and graft survival,” Gonzalo Crespo, MD, from the Hospital Clínic de Barcelona, Spain, and colleagues wrote. “Considering the tremendous impact of HCV recurrence in the results of LT, it is clear that DAA will dramatically change the scenario of liver transplantation, probably contributing also to long-term improvements in survival.”

The study comprised 1,483 patients listed for LT between Jan. 1, 2008, and Dec. 31, 2016, in Catalonia, Spain. Crespo and colleagues excluded patients listed for urgent transplantation and those with prior transplantations.

The total number of waitlist inclusions decreased from 180 in 2008 to 138 in 2016. HCV-related liver disease as indication decreased from 52% of listings in 2008 to 24% of listings in 2016, with the sharpest decrease taking place between 2015 and 2016 (P < .001). In contrast, nonalcoholic steatohepatitis-related indications increased from 3% in 2008 to 10% in 2016 (P = .001).

Among the HCV-related indications, decompensated cirrhosis decreased significantly during the study period, from 47% in 2008 to 24% in 2016 (P = .004).

Between 2008 and 2013, 57 patients who were positive for both anti-HCV and HCV RNA underwent antiviral therapy with pegylated interferon and ribavirin (n = 24), triple therapy (n = 5) with Victrelis (boceprevir, Merck) or Incivek (telaprevir, Vertex Pharmaceuticals), or direct-acting antivirals (n = 28). Sustained virologic response rates were 46% for patients who received pegylated-interferon and 80% for those who received triple therapy.

Between 2014 and 2016, 118 patients treated with direct-acting antivirals had an intention-to-treat SVR rate of 91%. The intention-to-treat SVR rate was 95% among patients with HCV and hepatocellular carcinoma, and 84% among those with decompensated cirrhosis.

Multivariate analysis showed that treatment during the 2014 to 2016 period (RR = 0.525; 95% CI, 0.349-0.791), anti-HCV positivity (RR = 1.589; 95% CI, 1.224-2.062), and livers from donors older than 56 years (RR = 1.459; 95% CI, 1.12-1.9) correlated with mortality. Patients who were anti-HCV negative had significantly better survival outcomes after transplantation.

“Although a direct effect of DAA therapy is difficult to demonstrate, we clearly show that survival improved only in LT recipients with HCV infection after the introduction of DAA therapies, and the time period was independently associated with survival in anti-HCV positive patients,” the researchers wrote. “Importantly, this was not the case in the remaining indications of LT.” – by Talitha Bennett

Disclosure: Crespo reports he is a consultant to Novartis. Please see the full study for the other authors’ relevant financial disclosures.