Clinical outcomes of patients undergoing antiviral therapy while awaiting liver transplantation

Fecha de publicación: 01/12/2017

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

Pascasio, JM
Ferrer, MT
Colmenero, J
Castells, L
Manzano, ML
Lorente, S
Testillano, M
Xiol, X
Molina, E
Gonzalez-Dieguez, L
Oton, E
Pascual, S
Santos, B
Herrero, JI
Salcedo, M
Montero, JL
Sanchez-Antolin, G
Narvaez, I
Nogueras, F
Giraldez, A
Forns, X
Londoño MC

Grupos

Hepatología experimental y Trasplante hepático

Investigador Principal

Laia Tolosa Pardo
Hepatología, Cirugia Hepatobiliopancreática y Trasplantes

Leader

Marina Berenguer Haym

Abstract

Background & Aims: Antiviral therapy for the treatment of hepatitis C (HCV) infection has proved to be safe and efficacious in patients with cirrhosis awaiting liver transplantation (LT). However, the information regarding the clinical impact of viral eradication in patients on the waiting list is still limited. The aim of the study was to investigate the probability of delisting in patients who underwent antiviral therapy, and the clinical outcomes of these delisted patients. Methods: Observational, multicenter and retrospective analysis was carried out on prospectively collected data from patients positive for HCV, treated with an interferon-free regimen, while awaiting LT in 18 hospitals in Spain. Results: In total, 238 patients were enrolled in the study. The indication for LT was decompensated cirrhosis (with or without hepatocellular carcinoma [HCC]) in 171 (72%) patients, and HCC in 67 (28%) patients. Sustained virologic response (SVR) rate was significantly higher in patients with compensated cirrhosis and HCC (92% vs. 83% in patients with decompensated cirrhosis with or without HCC, p = 0.042). Among 122 patients with decompensated cirrhosis without HCC, 29 (24%) were delisted due to improvement. No patient with baseline MELD score >20 was delisted. After delisting (median follow-up of 88 weeks), three patients had clinical decompensations and three had de novo HCC. Only two of the patients with HCC had to be readmitted onto the waiting list. The remaining 23 patients remained stable, with no indication for LT. Conclusions: Antiviral therapy is safe and efficacious in patients awaiting LT. A quarter of patients with decompensated cirrhosis can be delisted as a result of clinical improvement, which appears to be remain stable in most patients. Thus, delisting is a safe strategy that could spare organs and benefit other patients with a more urgent need. (C) 2017 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:: 1168-1176
DOI:: 10.1016/j.jhep.2017.08.008
Factor de Impacto:: 5,633 SCImago ℠
Cuartil:: Q1 SCImago ℠

Documentos

No hay documentos

Métricas

Filiaciones

Pascasio, JM:: UGC Digestive Diseases, Hospital Universitario Virgen del Rocío, IBIS, CIBERehd, Sevilla, Spain

Hosp Univ Virgen del Rocio, CIBERehd, IBIS, UGC Digest Dis, Seville, Spain
Vinaixa, C:: Liver Unit, Digestive Medicine Service, Hospital Universitario La Fé, CIBERehd, Valencia, Spain

Hosp Univ La Fe, Liver Unit, Digest Med Serv, CIBERehd, Valencia, Spain
Ferrer, MT:: UGC Digestive Diseases, Hospital Universitario Virgen del Rocío, IBIS, CIBERehd, Sevilla, Spain

Hosp Univ Virgen del Rocio, CIBERehd, IBIS, UGC Digest Dis, Seville, Spain
Colmenero, J:: Liver Unit, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain

Hosp Clin Barcelona, IDIBAPS, CIBERehd, Liver Unit, Barcelona, Spain
Rubin, A:: Liver Unit, Digestive Medicine Service, Hospital Universitario La Fé, CIBERehd, Valencia, Spain

Hosp Univ La Fe, Liver Unit, Digest Med Serv, CIBERehd, Valencia, Spain
Castells, L:: Internal Medicine Service, Hospital Universitari Vall d'Hebron, CIBERehd, Barcelona, Spain

Hosp Univ Vall dHebron, CIBERehd, Internal Med Serv, Barcelona, Spain
Manzano, ML:: Digestive Diseases Service, Hospital Universitario 12 Octubre, Madrid, Spain

Hosp Univ 12 Octubre, Digest Dis Serv, Madrid, Spain
Lorente, S:: Liver Transplant Unit, Digestive Diseases Service, Hospital Universitario Lozano Blesa, Zaragoza, Spain

Hosp Univ Lozano Blesa, Liver Transplant Unit, Digest Dis Serv, Zaragoza, Spain
Testillano, M:: Liver Unit, Digestive Diseases Service, Hospital Universitario Cruces, Vizcaya, Spain

Hosp Univ Cruces, Liver Unit, Digest Dis Serv, Vizcaya, Spain
Xiol, X:: Digestive Diseases Service, Hospital Universitari Bellvitge, Barcelona, Spain

Hosp Univ Bellvitge, Digest Dis Serv, Barcelona, Spain
Molina, E:: Abdominal Transplant Unit, CHU Santiago de Compostela, IDIS, Santiago, Spain

CHU Santiago de Compostela, IDIS, Abdominal Transplant Unit, Santiago, Spain
Gonzalez-Dieguez, L:: Liver Unit, Hospital Universitario Central de Asturias, Asturias, Oviedo, Spain

Hosp Univ Cent Asturias, Liver Unit, Oviedo, Spain
Oton, E:: Digestive Diseases Service, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain

Hosp Univ Nuestra Senora de Candelaria, Digest Dis Serv, Tenerife, Spain
Pascual, S:: Liver Unit, Hospital General Universitario, CIBERehd, Alicante, Spain

Hosp Gen Univ, CIBERehd, Liver Unit, Alicante, Spain
Santos, B:: Internal Medicine Service, Hospital Universitari Vall d'Hebron, CIBERehd, Barcelona, Spain

Hosp Univ Vall dHebron, CIBERehd, Internal Med Serv, Barcelona, Spain
Herrero, JI:: Liver Unit, Clínica Universitaria de Navarra, CIBERehd, IdiSNA, Pamplona, Spain

Clin Univ Navarra, Liver Unit, CIBERehd, IdiSNA, Pamplona, Spain
Salcedo, M:: Liver Transplant Unit, Hospital General Universitario Gregorio Marañón, CIBERehd, Madrid, Spain

Hosp Gen Univ Gregorio Maranon, CIBERehd, Liver Transplant Unit, Madrid, Spain
Montero, JL:: UGC Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, Spain

Hosp Univ Reina Sofia, UGC Aparato Digest, Cordoba, Spain
Sanchez-Antolin, G:: Liver Transplant Unit, Hospital Universitario Río Ortega, Valladolid, Spain

Hosp Univ Rio Ortega, Liver Transplant Unit, Valladolid, Spain
Narvaez, I:: Digestive Diseases Service, Hospital Universitario Infanta Cristina, Badajoz, Spain

Hosp Univ Infanta Cristina, Digest Dis Serv, Badajoz, Spain
Nogueras, F:: Digestive Diseases Service, Hospital Universitario Virgen de las Nieves, Granada, Spain

Hosp Univ Virgen de las Nieves, Digest Dis Serv, Granada, Spain
Giraldez, A:: UGC Digestive Diseases, Hospital Universitario Virgen del Rocío, IBIS, CIBERehd, Sevilla, Spain

Hosp Univ Virgen del Rocio, CIBERehd, IBIS, UGC Digest Dis, Seville, Spain
Prieto, M:: Liver Unit, Digestive Medicine Service, Hospital Universitario La Fé, CIBERehd, Valencia, Spain

Hosp Univ La Fe, Liver Unit, Digest Med Serv, CIBERehd, Valencia, Spain
Forns, X:: Liver Unit, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain

Hosp Clin Barcelona, IDIBAPS, CIBERehd, Liver Unit, Barcelona, Spain
Londoño MC:: Liver Unit, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain