Delisting of liver transplant candidates with chronic hepatitis C after viral eradication: A European study

Fecha de publicación: 01/09/2016

Autores de IIS La Fe

Marina Berenguer Haym

Autor
Carmen Vinaixa Aunés

Autor

Participantes ajenos a IIS La Fe

Belli LS
Cortesi PA
Strazzabosco M
Rockenschaub SR
Martini S
Morelli C
Donato F
Volpes R
Pageaux GP
Coilly A
Fagiuoli S
Amaddeo G
Perricone G
Berlakovich G
Facchetti R
Polak W
Muiesan P
Duvoux C
European Liver and Intestine Association (ELITA)

Grupos

Hepatología, Cirugia Hepatobiliopancreática y Trasplantes

Leader

Marina Berenguer Haym

Abstract

Background & Aims: All oral direct acting antivirals (DAA) have been shown to improve the liver function of patients with decompensated cirrhosis but it is presently unknown whether this clinical improvement may lead to the delisting of some patients. The aim of this study was to assess if and which patients can be first inactivated due to clinically improvement and subsequently delisted in a real life setting. Methods: 103 consecutive listed patients without hepatocellular carcinoma were treated with different DAA combinations in 11 European centres between February 2014 and February 2015. Results: The cumulative incidence of inactivated and delisted patients by competing risk analysis was 15.5% and 0% at 24 weeks, 27.6% and 10.3% at 48 weeks, 33.3% and 19.2% at 60 weeks. The 34 patients who were inactivated showed a median improvement of 3.4 points for MELD (delta MELD, p < 0.0001) and 2 points for Child-Pugh (CP) (delta-CP, p < 0.0001). Three variables emerged from the most parsimonious multivariate competing risk model as predictors of inactivation for clinical improvement, namely, baseline MELD classes (MELD 16-20: HR = 0.120; p = 0.0005, MELD > 20: HR = 0.042; p < 0.0001), delta MELD (HR = 1.349; p < 0.0001) and delta albumin (HR = 0.307; p = 0.0069) both assessed after 12 weeks of DAA therapy. Conclusions: This study showed that all oral DAAs were able to reverse liver dysfunction and favoured the inactivation and delisting of about one patient out-of-three and one patient out-of-five in 60 weeks, respectively. Patients with lower MELD scores had higher chances to be delisted. The longer term benefits of therapy need to be ascertained. Lay summary: The excellent efficacy and safety profile of the new drugs against Hepatitis C virus, "direct acting antivirals" or DAAs, have made antiviral therapy possible also for patients with advanced liver disease and for those on the waiting list for liver transplantation (LT). This study shows for the first time that the DAAs may lead to a remarkable clinical improvement allowing the delisting of one patient out of 5. (C) 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Datos de la publicación

ISSN/ISSNe:: 0168-8278, 1600-0641
Tipo:: Article
Páginas:: 524-531
DOI:: 10.1016/j.jhep.2016.05.010
Factor de Impacto:: 5,012 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Métricas

Filiaciones

Belli LS:: Department of Gastroenterology and Hepatology, Liver Unit, Niguarda Hospital, Milan, Italy.
Berenguer M:: Hepatology & Liver Transplantation Unit, Hospital Universitari I Politècnic La Fe, University of Valencia & Ciberhed, Valencia, Spain
Cortesi PA:: Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
Strazzabosco M:: Digestive Disease Section and International Centre for Digestive Health, School of Medicine and Surgery, University of Milano Bicocca and Yale University Liver Center, Department of Medicine, New Haven, USA
Rockenschaub SR:: Division of Transplantation, Department of Surgery, University of Vienna, Vienna, Austria
Martini S:: LiverTransplantation Center, Gastrohepatology Unit, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
Morelli C:: Liver and Multi-organ Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
Donato F:: Division of Digestive Diseases, 'Maggiore' University Hospital, Milan, Italy
Volpes R:: Mediterranean Institute for Transplant, Palermo, Italy
Pageaux GP:: Department of Hepatology, Gastroenterology, and Liver Transplantation, Centre Hospitalier Universitaire (CHU) Saint Eloi, Montpellier, France
Coilly A:: Centre Hepato-Biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, Villejuif, France
Fagiuoli S:: Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
Amaddeo G:: Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est University, Creteil, France
Perricone G:: Department of Gastroenterology and Hepatology, Liver Unit, Niguarda Hospital, Milan, Italy
Vinaixa C:: Hepatology & Liver Transplantation Unit, Hospital Universitari I Politècnic La Fe, University of Valencia & Ciberhed, Valencia, Spain
Berlakovich G:: Division of Transplantation, Department of Surgery, University of Vienna, Vienna, Austria
Facchetti R:: Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
Muiesan P:: Department of HPB Surgery & Liver Transplantation, University of Birmingham, UK
Duvoux C:: Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est University, Creteil, France