Impact of hepatitis C virus (HCV) antiviral treatment on the need for liver transplantation (LT)

BackgroundTherapies for hepatitis C virus (HCV) infection have revolutionized the treatment of patients with chronic HCV infection. The effect of these therapies on the epidemiology of liver transplantation (LT) has yet to be elucidated. AimTo establish whether the indications for LT have changed as a result of the introduction of new therapies for HCV. Materials and methodsWe conducted a retrospective study based on a prospectively maintained registry of patients who undergo LT at La Fe Hospital in Valencia from 1997 to 2016. An analysis of outcome measures over time stratified by LT indications was performed. ResultsFrom January 1997 to December 2016, 2379 patients were listed for LT. Of these, 1113 (47%) were listed for HCV cirrhosishepatocellular carcinoma (HCC). This percentage varied significantly over time declining from 48.8% in the 1997-2009 initial period (IFN-based regimens) to 33% in the 2014-2016 final period (DAAs regimens) (P=.03). However, during that period, the proportion of those included in the waiting list (WL) due to HCV-HCC increased significantly (P=.001). In addition, among HCV-positive waitlisted patients with decompensated cirrhosis without HCC, the proportion of those with an HCV-alcohol mixed etiology also increased significantly over time (P=.001). Of all HCV-positive waitlisted patients, 203 were eventually removed from the WL due to either clinical improvement (n=77) or more frequently worsening/death (n=126). ConclusionsThe proportion of patients wait-listed for LT for decompensated HCV cirrhosis has significantly decreased over time. These changes are possibly related to the large-scale use of direct-acting antivirals.