Indication for Liver Transplantation After Direct-Acting Agents in the Treatment of Patients With Hepatitis C

Arias, Ana; Herrera, María Trinidad Villegas; Sánchez, Alba Arco; Adel, Moisés El; Cabrera, Jennifer Triguero; Illescas, Cristina Plata; Osuna, Maria Carmen Montes; Villalba, Julio Santoyo; Moral, Jesús María Villar del

doi:10.1016/j.transproceed.2021.08.058

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…Another reason is the decrease in the number of new cases of HCV-induced decompensated liver cirrhosis and HCC [16]. The prevalence of HCV on the renal waiting list is mainly reduced by the safe use of DAAs even in advanced renal failure [17]. Several studies from Europe and the US have shown comparable results [18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Impact of the direct acting antivirals on chronic hepatitis C prevalence on the Swiss organ transplantation list: a retrospective analysis

Falcato,

Temperli,

Bruggmann

et al. 2023

Explor Dig Dis

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Aim: In Switzerland, the first access to interferon-free direct-acting antivirals (DAAs) for hepatitis C virus (HCV) treatment was in 2014. This study aimed to analyze the effects of DAAs on the yearly listed numbers of HCV RNA-positive (RNA+) patients and their mortality on the Swiss organ transplantation waiting list (SOWL). Methods: In this retrospective secondary time series analysis of yearly aggregated data on listed and delisted patients from a subset of HCV RNA+ patients on the SOWL, listed patients were grouped by the requested organ, and delisted patients by reason. Time series were split into two periods of equal length, the phases before and after DAA implementation, and the mean difference was tested using the Mann-Whitney U test. Results: From 2008 to 2019, 328 HCV RNA+ patients were listed on SOWL, 86.6% requesting liver, 11.6% kidney, and 1.8% other organ transplantations. A total of 285 RNA+ patients were delisted from SOWL: 14.7% died, 75.4% had been transplanted, and 9.8% were delisted without surgery. There were significant reductions of patients listed for requesting any organ (– 21.7, P = 0.004), liver (– 18.3, P = 0.004), or kidney (– 3.0, P = 0.031) comparing the periods before and after DAA launch. The mean number of delistings after transplantation (– 11.2, P = 0.010), or death (– 4, P < 0.001) show a significant reduction. Conclusions: With DAAs, the rising trend of HCV RNA+ people waiting for organs was broken, as was the increasing trend of mortality on the SOWL among HCV RNA+ individuals.

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Section: Discussionmentioning

confidence: 99%

Impact of the direct acting antivirals on chronic hepatitis C prevalence on the Swiss organ transplantation list: a retrospective analysis

Falcato,

Temperli,

Bruggmann

et al. 2023

Explor Dig Dis

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“…Median age at transplant decreased, while biologic MELD score at the time of LT increased. Incidence of HCV-cirrhosis decreased due to the introduction of direct-acting antivirals, [38][39][40][41] while alcohol-related liver disease has accelerated as a result of the COVID pandemic. 42 Recipients with HCC at LT decreased, re ecting national liver allocation changes adopted in 2020.…”

Section: Patient Characteristics Over Timementioning

confidence: 99%

Identification and Internal Validation of a Novel Pre-Transplant Biomarker Panel to Predict Mortality Following Liver Transplantation: The Liver Immune Frailty Index

Panayotova

Simonishvili

Nguyen

et al. 2023

Preprint

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Cirrhosis-related immune dysfunction is well recognized and may contribute to early mortality following liver transplant (LT). The purpose of the present study was to identify pre-transplant biomarkers of immune dysfunction (i.e., immune frailty) that might accurately predict risk of early mortality following LT. Patient plasma was collected immediately prior to LT (T0) and analyzed via Luminex (N=279). On multivariate analysis, HCV IgG, Fractalkine, and MMP3 were significant predictors of 1yr post-LT mortality and were utilized to comprise a novel Liver Immune Frailty Index (LIFI). The LIFI stratifies LT recipients into -low, -moderate, and –high risk tertiles. One-year mortality was 1.4% for LIFI-low, 12.7% for LIFI-moderate, and 58.3% for LIFI-high. Internal validation through bootstrap resampling with 2000 replicates demonstrated the final LIFI model predicts early post-LT mortality with C-statistic=0.84. This novel index may identify patients at risk for persistent severe immune dysfunction and early mortality following LT.

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“…From 2013-2021, median age at LT decreased, while biologic MELD score increased. Incidence of HCV-cirrhosis decreased due to introduction of direct-acting antivirals (DAAs), [49][50][51][52] while alcohol-related liver disease (ARLD) accelerated as a result of the COVID pandemic. 53 Recipients with HCC at LT decreased, re ecting liver allocation policy changes in 2020.…”

Section: Patient Characteristics Over Timementioning

confidence: 99%

Development and Internal Validation of a Novel Pre-Transplant Biomarker Panel to Predict Post-Liver Transplant Mortality

Panayotova,

Simonishvili,

Nguyen

et al. 2023

Preprint

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Current scoring systems accurately predict risk of pre-liver transplant (LT) mortality but fall short in estimation of post-LT survival. This study seeks to identify biomarkers of pre-LT immune dysfunction that predict mortality following LT. From 10/1/13-3/23/21, 279 cirrhotic patients underwent assessment of plasma biomarker (Luminex) and clinical variables immediately prior to LT (T0). Cox-proportional hazards modeling identified HCV IgG, Fractalkine, and MMP3 as multivariate predictors of 1-year mortality, with covariate selection by clinical importance and LASSO methodology. These were utilized to comprise the novel Liver Immune Frailty Index (LIFI), which stratifies recipients into -low, -moderate, and –high risk tertiles. One-year mortality was 1.4%, 12.7%, and 58.3% for LIFI-low, -moderate, and -high, respectively. Internal validation through bootstrap resampling with 2000 replicates demonstrates LIFI predicts early post-LT mortality with C-statistic=0.84 and Brier score of 0.04. LIFI may identify patients at risk for persistent severe immune dysfunction and early mortality following LT.

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Indication for Liver Transplantation After Direct-Acting Agents in the Treatment of Patients With Hepatitis C

Cited by 5 publications

References 9 publications

Impact of the direct acting antivirals on chronic hepatitis C prevalence on the Swiss organ transplantation list: a retrospective analysis

Impact of the direct acting antivirals on chronic hepatitis C prevalence on the Swiss organ transplantation list: a retrospective analysis

Identification and Internal Validation of a Novel Pre-Transplant Biomarker Panel to Predict Mortality Following Liver Transplantation: The Liver Immune Frailty Index

Development and Internal Validation of a Novel Pre-Transplant Biomarker Panel to Predict Post-Liver Transplant Mortality

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