8 reports on liver transplant outcomes in patients with HCV

Influences that affect liver transplantation outcomes comprise numerous hepatic and extrahepatic factors, including hepatitis C infection. Patients with HCV are at risk for progression to liver damage and cirrhosis, which can affect the rate of waitlist mortality. In recent years, the introduction of direct-acting antivirals and improved management of cirrhosis have led to better outcomes post-liver transplant.

The following recent reports cover liver transplantation outcomes and waitlist predictive factors related to HCV infection, including cases in which patients also had diabetes, and comorbidities such as hepatitis B, as well as the safety and efficacy of preemptive DAA therapy.

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.” Read more

HCV liver cancer resection outcomes similar in patients with diabetes

Results of a comparative study of patients with and without diabetes who underwent curative liver resection for hepatitis C-related hepatocellular carcinoma showed that diabetes did not affect surgical outcomes and was not an unfavorable factor in selecting candidates.

“It is still controversial whether [diabetes] influences the survival of patients with HCC after resection. Such discrepancies in the results in each investigation could be attributed to the diversity of patient backgrounds, as well as the number of patients,” Naoki Yoshida, MD, from the Nihon University School of Medicine, Japan, and colleagues wrote. “In the present study, [diabetes] did not appear to have a negative impact on patients’ survival after HCC resection, suggesting that [diabetes] is not an exclusion criterion for HCC surgery under good glycemic control.” Read more

NASH, HCV cirrhosis predict coronary artery disease in liver transplantation

Patients who underwent liver transplantation evaluation had a high prevalence of coronary artery disease, especially those with nonalcoholic steatohepatitis-related cirrhosis, hepatitis C-related cirrhosis and alcoholic cirrhosis, according to a recently published study.

“An integral component of the liver transplant evaluation (LTE) is coronary artery disease (CAD) assessment as surgical morbidity and mortality can be as high as 81% and 50%, respectively, in patients with significant CAD undergoing LT,” Samarth S. Patel, MD, from the Virginia Commonwealth University, and colleagues wrote. “We conducted the following study to describe the distribution of CAD noted on per-protocol coronary angiography in patients undergoing LTE, risk factors associated with CAD and complications associated with coronary angiography.” Read more

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HCV nucleic acid test offers ‘opportunity’ to increase liver transplant pool

Utilizing hepatitis C antibody-positive but nucleic acid test-negative liver donors for HCV-negative liver transplant recipients opens liver transplant options, allowing for the use of livers available due to drug overdose, according to experts.

“Now that we have [nucleic acid testing (NAT)] available, that should be considered in labeling the donors rather than hepatitis C-positive or not,” Khurram Bari, MD, from the University of Cincinnati, told Healio Gastroenterology and Liver Disease. “NAT testing is a better indicator of hepatitis C positivity or negativity in donors, not just antibody. The antibody test can be nonspecific; it can positive, but if the NAT is negative there is a much lower risk for hepatitis C transmission.” Read more

Alcoholic liver disease overtakes HCV as leading indication on liver waitlist

An analysis of the liver waitlist revealed that as the total number of liver transplantations in the U.S. has increased each year, alcoholic liver disease has become the leading indication over hepatitis C.

“Data through 2015 demonstrated a decline in the number of HCV-related LT waitlist registrations and LT surgeries following the introduction of [direct-acting antiviral]-based regimens. Despite the downtrend, primary diagnosis of HCV remained the most common etiology for liver transplantation in the U.S. until the end of 2015,” George Cholankeril, MD, and Aijaz Ahmed, MD, from Stanford University School of Medicine, wrote. “In 2016, ALD became the leading indication for LT waitlist additions in the U.S. by surpassing HCV.” Read more

Liver waitlist outcomes for patients with HCV improving in recent years

In recent years, mortality rates and progression of disease severity has decreased among patients with hepatitis C on the liver transplant waitlist, according to recently published data.

“The improvement in survival and disease progression in this population could be attributed to improvement in the management of cirrhosis complications, advances in the quality of medical care in general, access to LT, or perhaps a difference in the selection of patients referred and listed for LT; however, the difference between HCV and non-HCV patients points to factors that are specific to HCV,” Allison Kwong, MD, from the Stanford University School of Medicine, California, and colleagues wrote. Read more

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Preemptive DAA therapy viable for HCV-positive liver transplantation

Results of a virtual trial showed that transplantation with hepatitis C-positive livers with preemptive direct-active antiviral therapy may be a viable option for improving patient survival on the liver transplant waitlist, according to an expert at The Liver Meeting 2017.

“The fact is that donor liver availability continues to be limiting factor in increasing the number of liver transplants. Therefore, it becomes very important that we utilize all organs for a maximum potential,” Jagpreet Chhatwal, PhD, from the Massachusetts General Hospital and Harvard Medical School, said in his presentation. “However, under current guidelines, [hepatitis] C-positive livers are not transplanted into [hepatitis] C-negative recipients because of adverse post-transplant outcomes previously demonstrated in the interferon-based therapy [era]. But several things have changed in the last few years that prompt us to revisit this question. In particular, the availability of [hepatitis] C-positive liver donors has increased substantially because of the ongoing opioid epidemic.” Read more

HBV, HCV diagnoses show improved timing in late-stage liver disease

Late diagnosis of hepatitis B and hepatitis C has declined over time among patients with decompensated cirrhosis and those with hepatocellular carcinoma, according to a recently published study. Further, patients with more regular physician visits and lower risk activities were diagnosed earlier.

“Early detection and treatment of HBV and HCV can avert cases of late stage liver disease and improve overall prognosis for patients. ‘Late diagnosis’ of HBV and HCV represents a missed opportunity to reduce risk of liver disease progression and also a potential area that can be targeted for substantive improvement in the realm of hepatitis care,” Hasina Samji, PhD, from the BC Center for Disease Control, British Columbia, and colleagues wrote. Read more