Treatment with direct-acting antiviral agents (DAAs) in patients with decompensated cirrhosis caused by HCV infection could enable the removal of a fifth of these individuals from liver transplantation waiting lists, according to a new study.
The availability of safe and effective DAAs has transformed the treatment of patients infected with HCV within the past few years, yielding a sustained viriologic response in >90% of patients with HCV-related compensated cirrhosis. However, the clinical benefit of these drugs in patients with more severe HCV-related decompensated cirrhosis who require liver transplantation was previously unknown.
Luca Saverio Belli and colleagues therefore carried out a multicentre retrospective study examining the effect of DAA treatment in 103 patients with decompensated HCV-related cirrhosis who were all initially listed for liver transplantation. The team found that DAA administration resulted in clinical improvement that merited waiting-list inactivation in one in three patients, with one in five patients delisted altogether following a substantial recovery. Furthermore, so-called inactivated patients showed an improvement in both Model for End-stage Liver Disease and Child–Pugh prognosis scoring systems and 16 patients experienced a complete regression in liver decompensation signs.
“DAA treatment and associated delisting could significantly reduce the need [for liver transplantation] ... and save organs,” the researchers write in their discussion. The team also suggest that follow-up studies are now required to determine the long-term mortality in patients with HCV-related decompensated cirrhosis who have received DAAs.
References
Belli, L. S. et al. Delisting of liver transplant candidates with chrnic hepatitic c after viral eradication: a European study. J. Hepatol. http://dx.doi.org/10.1016/j.jhep.2016.05.010 (2016)
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Ridler, C. HCV drugs reduce transplantation need. Nat Rev Gastroenterol Hepatol 13, 376 (2016). https://doi.org/10.1038/nrgastro.2016.92
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DOI: https://doi.org/10.1038/nrgastro.2016.92