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Patients Treated for HCV Infection and Listed for Liver Transplantation in a French Multicenter Study: What Happens
Lucy Meunier1, Mohamed Belkacemi2, George Philippe Pageaux1
1Montpellier Saint Eloi University Hospital, 80 Avenue Augustin Fliche, 34090 Montpellier, France.
Insights
Direct-acting antivirals (DAAs) effectively treat hepatitis C virus (HCV) in patients awaiting liver transplants. Viral eradication can lead to a quarter of cirrhosis patients being delisted due to improved health.
Area of Science:
- Hepatology
- Virology
- Transplantation Medicine
Background:
- Direct-acting antiviral (DAA) agents offer a safe and effective treatment for hepatitis C virus (HCV) infection.
- Long-term clinical impact data of viral eradication in patients awaiting liver transplantation (LT) for decompensated cirrhosis or hepatocellular carcinoma (HCC) are limited.
- This study investigates the long-term outcomes of HCV treatment in patients awaiting LT, focusing on delisting and HCC evolution.
Purpose of the Study:
- To evaluate the clinical outcomes of patients awaiting liver transplantation (LT) after direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) infection.
- To determine the rate of delisting from LT waiting lists due to clinical improvement following HCV eradication.
- To analyze the evolution of hepatocellular carcinoma (HCC) and recurrence post-LT in patients treated with DAAs.
Main Methods:
- An observational, multicenter, retrospective analysis of prospectively collected data from 179 HCV-positive patients undergoing DAA treatment.
- Patients were treated with interferon-free regimens while awaiting LT across 18 French hospitals.
- Data collection focused on sustained virological response, treatment tolerability, delisting criteria, HCC status, and post-transplant outcomes.
Main Results:
- A sustained virological response of 84.4% was achieved with DAAs, demonstrating good tolerability.
- Among 75 patients with cirrhosis, 19 (25.3%) were delisted due to clinical improvement; absence of ascites and lower MELD/Child-Pugh scores predicted delisting.
- Of 104 patients with HCC, 82 (78.9%) underwent LT, with a low dropout rate and minimal HCC recurrence post-transplant.
Conclusions:
- DAAs are safe and effective for HCV treatment in patients awaiting LT for cirrhosis or HCC.
- Approximately 25% of patients with cirrhosis awaiting LT may be delisted following successful HCV treatment and clinical improvement.
- Identifying predictive factors for delisting can aid clinicians in managing HCV treatment strategies for patients on LT waiting lists.
Background:
Direct-acting antiviral (DAA) agents for the treatment of hepatitis C virus (HCV) infection have been proven safe and effective in cirrhotic patients awaiting liver transplantation (LT). However, in the long term, data remain minimal regarding the clinical impact of viral eradication on patients listed for decompensated cirrhosis or hepatocellular carcinoma (HCC). We aimed to elucidate the clinical outcomes of patients regarding delisting and the evolution of HCC during the long-term follow-up.
Methods:
An observational, multicenter, retrospective analysis was carried out on prospectively collected data from HCV-positive patients treated with an interferon-free regimen while awaiting LT in 18 French hospitals.
Results:
A total of 179 patients were included in the study. The indication for LT was HCC in 104 (58.1%) patients and cirrhosis in 75 (41.9%) patients. The sustained virological response was 84.4% and the treatment was well tolerated. At five years, among 75 patients with cirrhosis treated for HCV, 19 (25.3%) were delisted following improvement after treatment. Predictive factors for delisting highlighted an absence of ascites, MELD score ≤ 15, and Child-Pugh score ≤ 7. No patients with refractory ascites were delisted. Among patients with HCC, 82 (78.9%) were transplanted. The drop-out rate was low (6.7%) and few recurrences of HCC after LT were observed.
Conclusions:
DAAs are safe and effective in patients awaiting LT for cirrhosis or HCC. A quarter of patients with cirrhosis can be delisted because of clinical improvement. Predictive factors for delisting, as a result of improvement, may assist prescribers, before initiating HCV infection therapy in the long-term perspective.
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