Copyright
©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Hepatitis C virus related cirrhosis decreased as indication to liver transplantation since the introduction of direct-acting antivirals: A single-center study
Alberto Ferrarese, Giacomo Germani, Martina Gambato, Francesco Paolo Russo, Marco Senzolo, Alberto Zanetto, Sarah Shalaby, Umberto Cillo, Giacomo Zanus, Paolo Angeli, Patrizia Burra
Alberto Ferrarese, Giacomo Germani, Martina Gambato, Francesco Paolo Russo, Marco Senzolo, Alberto Zanetto, Sarah Shalaby, Patrizia Burra, Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, via Giustiniani 2, Padua 35128, Italy
Umberto Cillo, Giacomo Zanus, Hepatobiliary Surgery and Liver Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, via Giustiniani 2, Padua 35128, Italy
Paolo Angeli, Internal Medicine, Department of Medicine, Padua University Hospital, via Giustiniani 2, Padua 35128, Italy
Author contributions: Ferrarese A, Germani G and Burra P participated in research design, in the performance of the research and in data analysis. Russo FP, Gambato M, Zanetto A, Shalaby S, Senzolo M, Cillo U, Zanus G and Angeli P participated in research design. All Authors approved the final manuscript.
Institutional review board statement: The study protocol was approved by all members of the Local Ethical Committee “Comitato Etico per la Sperimentazione Clinica della Provincia di Padova” (protocol n. 4466/AO/18; code AOP1405).
Informed consent statement: Informed consent protocol was approved by the Local Ethical Committee. Informed consent was collected and signed by all patients included in the study.
Conflict-of-interest statement: All the Authors declare no conflict of interest regarding this paper.
Data sharing statement: Individual de-identified participant data have been anonymously collected.
STROBE statement: The manuscript has been prepared according to the STROBE statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Patrizia Burra, MD, PhD, Professor, Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, via Giustiniani 2, Padova 35128, Italy. burra@unipd.it
Telephone: +39-49-8212892 Fax: +39-49-8218727
Received: June 7, 2018
Peer-review started: June 7, 2018
First decision: July 11, 2018
Revised: July 26, 2018
Accepted: August 1, 2018
Article in press: August 1, 2018
Published online: October 14, 2018
AIM
To evaluate waiting list (WL) registration and liver transplantation (LT) rates in patients with hepatitis C virus (HCV)-related cirrhosis since the introduction of direct-acting antivirals (DAAs).
METHODS
All adult patients with cirrhosis listed for LT at Padua University Hospital between 2006-2017 were retrospectively collected using a prospectively-updated database; patients with HCV-related cirrhosis were divided by indication for LT [dec-HCV vs HCV/ hepatocellular carcinoma (HCC)] and into two interval times (2006-2013 and 2014-2017) according to the introduction of DAAs. For each patient, indications to LT, severity of liver dysfunction and the outcome in the WL were assessed and compared between the two different time periods. For patients receiving DAA-based regimens, the achievement of viral eradication and the outcome were also evaluated.
RESULTS
One thousand one hundred and ninty-four [male (M)/female (F): 925/269] patients were included. Considering the whole cohort, HCV-related cirrhosis was the main etiology at the time of WL registration (490/1194 patients, 41%). HCV-related cirrhosis significantly decreased as indication to WL registration after DAA introduction (from 43.3% in 2006-2013 to 37.2% in 2014-2017, P = 0.05), especially amongst dec-HCV (from 24.2% in 2006-2013 to 15.9% in 2014-2017, P = 0.007). Even HCV remained the most common indication to LT over time (289/666, 43.4%), there was a trend towards a decrease after DAAs introduction (from 46.3% in 2006-2013 to 39% in 2014-2017, P = 0.06). HCV patients (M/F: 43/11, mean age: 57.7 ± 8 years) who achieved viral eradication in the WL had better transplant-free survival (log-rank test P = 0.02) and delisting rate (P = 0.002) than untreated HCV patients.
CONCLUSION
Introduction of DAAs significantly reduced WL registrations for HCV related cirrhosis, especially in the setting of decompensated cirrhosis.
Core tip: All-oral direct-acting antivirals significantly modify the natural history of hepatitis C virus (HCV) infection. According to our study, liver transplantation for HCV decompensated cirrhosis will decrease in the next future.
