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Outcome of hepatitis C–related liver transplantation in direct-acting antiviral era

Indian Journal of Gastroenterology volume 39, pages 539–543 (2020)Cite this article

Abstract

Background

Hepatitis C virus (HCV) has become an easily treatable disease after the introduction of sofosbuvir-based direct-acting antiviral (DAA) regimens. This is a large single center experience of changing severity and outcome profile of HCV-related liver disease after availability of DAAs.

Methods

A retrospective analysis of prospectively collected liver transplantation (LT) database of adults (age > 18 years at the time of LT) was performed from June 2010 to July 2018. A total of 410 patients (including 26 co-infection with hepatitis B) underwent LT for hepatitis C–related decompensated cirrhosis and/or hepatocellular carcinoma (HCC) out of 1754 adult transplantation in the defined period.

Results

The study group comprised of 296 males and 114 females aged 52.1 ± 7.9 years. HCV-related decompensated cirrhosis and/or HCC as indication of LT was present in 289/1016 (28.4%) during 2010–2014, which was reduced to 121/738 (16.3%) during 2015–2018 (p = 0.000). The LT recipients for HCV-related cirrhosis had significantly lower Child’s and model for end-stage liver disease (MELD) score during 2015–2018 as compared to that during 2010–2014; Child’s score was 7.9 ± 2.2 vs. 8.6 ± 2.1, p = 0.003; MELD score was 13.9 ± 5.3 vs. 17.1 ± 5.8, p = 0.000, respectively. There was a trend towards better survival in HCV patients during 2015–2018 as compared to that during 2010–2014. Significantly more patients had HCV RNA negative status before LT during 2015–2018 (38.8% vs. 13%, p = 0.000); moreover, the proportion of LT for decompensated cirrhosis (without HCC) decreased significantly in the latter period, 64.0% vs. 42.1% (p = 0.000).

Conclusion

In the DAA era, HCV as an indication for LT has decreased and patients have less severe disease at transplantation. There is a trend towards better patient survival.

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Acknowledgments

Mr. Yogesh Saini (research coordinator), Mr. Manish K Singh (biostatistician).

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Affiliations

  1. Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity Hospital, Sector 38, Gurugram, Delhi (NCR), 122 413, India

    Narendra S. Choudhary, Neeraj Saraf, Sanjiv Saigal, Amit Rastogi, Prashant Bhangui, Srinivas Thiagrajan & Arvinder S. Soin

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  1. Narendra S. Choudhary
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  2. Neeraj Saraf
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  3. Sanjiv Saigal
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  4. Amit Rastogi
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  5. Prashant Bhangui
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  7. Arvinder S. Soin
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Contributions

NSC and NS: concept and initial draft; AR, PB, and ST: draft and data analysis; NS, SS, and AS: critical revision.

Corresponding author

Correspondence to Neeraj Saraf.

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NSC, NS, SS, AR, PB, ST, and ASS declare that they have no conflict of interest.

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The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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Choudhary, N.S., Saraf, N., Saigal, S. et al. Outcome of hepatitis C–related liver transplantation in direct-acting antiviral era. Indian J Gastroenterol 39, 539–543 (2020). https://doi.org/10.1007/s12664-020-01105-z

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Keywords

  • Anti-viral treatment
  • Chronic liver disease
  • Cirrhosis
  • Hepatitis C virus
  • Hepatocellular carcinoma
  • Liver transplantation
  • MELD score
  • Recurrence
  • Sofosbuvir
  • Survival