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
ARTICLE HIGHLIGHTS
Research background
Hepatitis C virus (HCV)-related cirrhosis has been the first indication for liver transplantation in Western Countries in the last decades. Introduction of all-oral direct-acting antivirals (DAAs) significantly modified the natural history of HCV related liver disease.
Research motivation
Our study aimed at evaluating the change in waiting list registrations and in liver transplantation for HCV related cirrhosis after DAAs introduction.
Research objectives
To evaluate the outcome of patients with HCV related cirrhosis, listed for liver transplantation at Padua University Hospital between 2006 and 2017. Patients were further divided according to two different time periods (2006-2013 vs 2014-2017) and according to indication to liver transplantation (decompensated disease vs hepatocellular carcinoma).
Research methods
The outcome of patients listed for liver transplantation (LT) for HCV related cirrhosis was retrospectively analysed using a prospectively updated database.
Research results
After DAAs introduction, HCV-related cirrhosis significantly decreased as indication to waiting list registration, especially among patients with decompensated disease. Considering liver transplantation, even HCV remained the most common indication to LT over time (289/666, 43.4%), there was a trend towards a decrease in the last time period (2013-2017). Furthermore, HCV patients who achieved viral eradication had better transplant-free survival than untreated HCV patients.
Research conclusions
The study demonstrated that HCV related cirrhosis might be a decreasing indication to liver transplantation, especially for decompensated liver disease. Viral eradication achieved with DAA-based regimens should reduce decompensation rates and need to LT. This study confirmed what already known in literature about the beneficial role provided by DAAs in patients with HCV related cirrhosis. Viral eradication obtained after DAAs- based regimens should reduce decompensation rates amongst patients with HCV related cirrhosis. Future studies are needed to confirm the changing scenario regarding indications to LT in Western countries.
Research perspectives
Viral eradication obtained after DAA therapy should reduce decompensation rates amongst patients with HCV related cirrhosis. To further investigate trends in waiting list registrations and liver transplantations for HCV related cirrhosis, especially in the setting of hepatocellular carcinoma. Larger, multicentre, prospective studies are the best methods for the future research.
