Impact of direct anti-viral agents on inactivation/de-listing of liver transplant candidates listed for decompensated C cirrhosis: a European study

liver_clip_image003Background and Aims: Preliminary reports indicate that in Liver Transplant candidates listed for Hepatitis C virus (HCV) decompensated cirrhosis, Direct-Acting Antivirals (DAA) therapy may result in liver function improvement. Whether this clinical improvement translates into the delisting of some patients is presently unknown. Therefore, the major object of this study was to assess if and which patients can be first inactivated due to clinically improvement and subsequently delisted in a real life setting.

Methods: Retrospective multicentre European study conducted on 103 consecutive liver transplant candidates with decompensated cirrhosis without hepatocellular carcinoma treated with different DAA combinations.

Results: The cumulative incidence of inactivated and delisted patients by competing risk analysis was 16% and 0% at 24 weeks and 35%} and 20% at 48 weeks after start of DAAs. The 25 patients that were inactivated showed a median improvement of 4 points for MELD (Delta MELD, p <0.0001) and 3 points for Child-Pugh (Delta-Child-Pugh, p <0.0001). Three variables emerged from the most parsimonious Multivariate competing risk model as predictors of inactivation for clinical improvement, namely, baseline MELD (HR = 0.819; p = 0.0004), Delta-MELD (HR = 1.311; p <0.0001) and Delta-Albumin (HR = 0.419; p = 0.0041) both assessed after12 weeks of DAAs therapy.

Conclusions: In decompensated cirrhotics listed for liver transplantation, second generation DAAs favoured the inactivation and delisting of about one patient out-of-three and one patient out-of-five in 1 year, respectively. Patients with lower MELD scores have higher chances to be delisted. These results are expected to have a major impact on the management of listed patients and on organ need in programs with high prevalence of C cirrhosis.

Luca S. Belli* 1, Marina Berenguer2, Susanne-Rasoul Rockenschaub3, Silvia Martini4, Cristina Morelli5, Francesca Donato6, Riccardo Volpes7, Georges-Philippe Pageaux8, Audrey Coilly9, Stefano Fagiuoli10, Paolo Cortesi11, Christophe Duvoux12 and for the European Liver and Intestine Association (ELITA)

Reported by Jules Levin
EASL 2016 E=April 14-17 Barcelona