Influence of antiviral therapy in the long‐term outcome of recurrent hepatitis C virus infection following liver transplantation

García‐Reyne, Ana; Lumbreras, Carlos; Fernández, Inmaculada; Colina, F; Abradelo, M.; Magan, Priyan; Juan, Rafael San; Manrique, Alejandro; López‐Medrano, Francisco; Fuertes, A; Lizasoaín, Manuel; Moreno, Enrique; Aguado, José María

doi:10.1111/tid.12097

Cited by 10 publications

(7 citation statements)

References 42 publications

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“…The present study found a significantly higher overall SVR rate of 54.1% and this difference could be justified by the prolonged duration of treatment (median of 68 weeks) when compared to other studies in which patients were treated for 48 weeks on average (10,12,14,16,18–25,27,28). Besides, in the population studied there was a considerable difference in length of treatment among SVR and non-SVR patients.…”

Section: Discussioncontrasting

confidence: 54%

Survival benefits of interferon-based therapy in patients with recurrent hepatitis C after orthotopic liver transplantation

Zanaga

Vigani

Angerami

et al. 2017

Braz J Med Biol Res

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Recurrent hepatitis C after orthotopic liver transplantation (OLT) is universal and can lead to graft failure and, consequently, reduced survival. Hepatitis C treatment can be used to prevent these detrimental outcomes. The aim of this study was to describe rates of hepatitis C recurrence and sustained virological response (SVR) to interferon-based treatment after OLT and its relationship to survival and progression of liver disease through retrospective analysis of medical records of 127 patients who underwent OLT due to cirrhosis or hepatocellular carcinoma secondary to chronic hepatitis C between January 2002 and December 2013. Fifty-six patients were diagnosed with recurrent disease, 42 started interferon-based therapy and 37 completed treatment. Demographic, treatment- and outcome-related variables were compared between SVR and non-responders (non-SVR). There was an overall 54.1% SVR rate with interferon-based therapies. SVR was associated with longer follow-up after treatment (median 66.5 vs 37 months for non-SVR, P=0.03) and after OLT (median 105 vs 72 months, P=0.074), and lower rates of disease progression (15 vs 64.7%, P=0.0028) and death (5 vs 35.3%, P=0.033). Regardless of the result of therapy (SVR or non-SVR), there was a significant difference between treated and untreated patients regarding the occurrence of death (P<0.001) and months of survival (P<0.001). Even with suboptimal interferon-based therapies (compared to the new direct-acting antivirals) there is a 54.1% SVR rate to treatment. SVR is associated with improved survival and reduced risks of clinical decompensation, loss of the liver graft and death.

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Section: Discussioncontrasting

confidence: 54%

Survival benefits of interferon-based therapy in patients with recurrent hepatitis C after orthotopic liver transplantation

Zanaga

Vigani

Angerami

et al. 2017

Braz J Med Biol Res

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“…The most significant aspect of our analysis is the observed rapid increase in frequency and excellent outcomes following transplantation of organs from DNAT + /Rpatients, a practice that has been rare because of the high probability of HCV transmission and associated morbidity. (23,24) Even LT recipients of an HCV serology-positive graft with negative HCV NAT had a 16% transmission rate in a small case series. (25) The current data support the fact that DAA therapy has changed the landscape of not only HCV management, but also LT. DAA therapy has allowed the opportunity to expand the use of HCV-positive liver donors, given that highly effective therapy is now available.…”

Section: Discussionmentioning

confidence: 98%

“…The most significant aspect of our analysis is the observed rapid increase in frequency and excellent outcomes following transplantation of organs from DNAT + /R – patients, a practice that has been rare because of the high probability of HCV transmission and associated morbidity . Even LT recipients of an HCV serology‐positive graft with negative HCV NAT had a 16% transmission rate in a small case series .…”

Section: Discussionmentioning

confidence: 98%

Increasing Utilization and Excellent Initial Outcomes Following Liver Transplant of Hepatitis C Virus (HCV)‐Viremic Donors Into HCV‐Negative Recipients: Outcomes Following Liver Transplant of HCV‐Viremic Donors

et al. 2019

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Direct‐acting antiviral (DAA) therapy has altered the frequency and outcome of liver transplantation (LT) for hepatitis C virus (HCV). The high efficacy and tolerability of DAA therapy has also created a rationale for utilizing HCV‐viremic (HCV‐RNA–positive) donors, including into HCV‐negative recipients. We examined trends in frequency of organ utilization and graft survival in recipients of HCV‐viremic donors (HCV‐RNA positive as measured by nucleic acid testing [NAT]). Data were collected from the Scientific Registry of Transplant Recipients (SRTR) on adult patients who underwent a primary, single‐organ, deceased donor LT from January 1, 2008 to January 31, 2018. Outcomes of HCV‐negative transplant recipients (R–) who received an allograft from donors who were HCV‐RNA positive (DNAT+) were compared to outcomes for R– patients who received organs from donors who were HCV‐RNA negative (DNAT–). There were 11,270 DNAT–/R–; 4,748 DNAT–/R+; 87 DNAT+/R–; and 753 DNAT+/R+ patients, with 2‐year graft survival similar across all groups: DNAT–/R– 88%; DNAT–/R+ 88%; DNAT+/R– 86%; and DNAT+/R+ 90%. Additionally, there were 2,635 LTs using HCV antibody‐positive donors (DAb+): 2,378 DAb+/R+ and 257 DAb+/R–. The annual number of DAb+/R– transplants increased from seven in 2008 to 107 in 2017. In the post‐DAA era, graft survival improved for all recipients, with 3‐year survival of DAb+/R– patients and DAb+/R+ patients increasing to 88% from 79% and to 85% from 78%, respectively. Conclusion: The post‐DAA era has seen increased utilization of HCV‐viremic donor livers, including HCV‐viremic livers into HCV‐negative recipients. Early graft outcomes are similar to those of HCV‐negative recipients. These results support utilization of HCV‐viremic organs in selected recipients both with and without HCV infection.

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“…HCV is a long-known survival predictor in LTs performed with aged donors. HCV recurrence is earlier and more aggressive when aged donors are used[34-38]. In most of the studies performed with donors older than 70 years, we also observed that HCV was an independent predictor of graft survival[13,26,30-32].…”

Section: Discussionmentioning

confidence: 66%

Analyzing predictors of graft survival in patients undergoing liver transplantation with donors aged 70 years and over

Caso-Maestro

Jiménez-Romero

Alonso

et al. 2018

WJG

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AIMTo increase the number of available grafts.METHODSThis is a single-center comparative analysis performed between April 1986 and May 2016. Two hundred and twelve liver transplantation (LT) were performed with donors ≥ 70 years old (study group). Then, we selected the first cases that were performed with donors < 70 years old immediately after the ones that were performed with donors ≥ 70 years old (control group).RESULTSGraft and patient survivals were similar between both groups without increasing the risk of complications, especially primary non-function, vascular complications and biliary complications. We identified 5 risk factors as independent predictors of graft survival: recipient hepatitis C virus (HCV)-positivity [hazard ratio (HR) = 2.35; 95% conﬁdence interval (CI): 1.55-3.56; P = 0.00]; recipient age (HR = 1.04; 95%CI: 1.02-1.06; P = 0.00); donor age X model for end-stage liver disease (D-MELD) (HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); donor value of serum glutamic-pyruvic transaminase (HR = 1.00; 95%CI: 1.00-1.00; P = 0.00); and donor value of serum sodium (HR = 0.96; 95%CI: 0.94-0.99; P = 0.00). After combining D-MELD and recipient age we obtained a new scoring system that we called DR-MELD (donor age X recipient age X MELD). Graft survival significantly decreased in patients with a DR-MELD score ≥ 75000, especially in HCV patients (77% vs 63% at 5 years in HCV-negative patients, P = 0.00; and 61% vs 25% at 5 years in HCV-positive patients; P = 0.00).CONCLUSIONA DR-MELD ≥ 75000 must be avoided in order to obtain the best results in LT with donors ≥ 70 years old.

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Influence of antiviral therapy in the long‐term outcome of recurrent hepatitis C virus infection following liver transplantation

Abstract: In conclusion, donor age, pre-transplant VL, and over-immunosuppression were associated with the long-term development of severe HCV recurrence in liver grafts. Administration of a full course of antiviral therapy was associated with better survival.

Cited by 10 publications

References 42 publications

Survival benefits of interferon-based therapy in patients with recurrent hepatitis C after orthotopic liver transplantation

Survival benefits of interferon-based therapy in patients with recurrent hepatitis C after orthotopic liver transplantation

Increasing Utilization and Excellent Initial Outcomes Following Liver Transplant of Hepatitis C Virus (HCV)‐Viremic Donors Into HCV‐Negative Recipients: Outcomes Following Liver Transplant of HCV‐Viremic Donors

Analyzing predictors of graft survival in patients undergoing liver transplantation with donors aged 70 years and over

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