Giovanni Perricone1, Christophe Duvoux2, Marina Berenguer3, Paolo A Cortesi4, Carmen Vinaixa5, Rita Facchetti4, Chiara Mazzarelli1, Susanne-Rasoul Rockenschaub5, Silvia Martini6, Cristina Morelli7, Sara Monico8, Riccardo Volpes9, Georges-Philippe Pageaux10, Stefano Fagiuoli11, Luca S Belli1,12. 1. Gastroenterology and Hepatology Unit, Liver Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 2. Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, AssistancePublique-Hôpitaux de Paris, Paris-Est University, Creteil, France. 3. Hepatology & Liver Transplantation Unit, Hospital Universitari I Politècnic La Fe, University of Valencia & Ciberhed, Valencia, Spain. 4. Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy. 5. Division of Transplantation, Department of Surgery, University of Vienna, Vienna, Austria. 6. Liver Transplantation Center, Gastro-Hepatology Unit, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy. 7. Liver and Multi-organ Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 8. Division of Digestive Diseases, 'Maggiore' University Hospital, Milan, Italy. 9. Hepatology and Gastroenterology Unit, ISMETT, Palermo, Italy. 10. Department of Hepatology, Gastroenterology, and Liver Transplantation, Centre HospitalierUniversitaire (CHU) Saint Eloi, Montpellier, France. 11. Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy. 12. International Center for Disease Health (ICDH), University of Milan-Bicocca, Monza, Italy.
Abstract
BACKGROUNDS & AIMS: Treating patients with decompensated cirrhosis with direct-acting antiviral (DAA) therapy while on the waiting list for liver transplantation results in substantial improvement of liver function allowing 1 in 4 patients to be removed from the waiting list or delisted, as reported in a previous study promoted by the European Liver and Intestine Transplant Association (ELITA). The aim of this study was to report on clinical outcomes of delisted patients, including mortality risk, hepatocellular carcinoma development and clinical decompensation requiring relisting. METHODS: One hundred and forty-two HCV-positive patients on the liver transplant waiting list for decompensated cirrhosis, negative for hepatocellular carcinoma, between February 2014 and June 2015 were treated with DAA therapy and were prospectively followed up. RESULTS: Forty-four patients (30.9%) were delisted following clinical improvement. This percentage was higher than in the original study because of a number of patients being delisted long after starting DAAs. The median Child-Pugh and MELD score of delisted patients was 5.5 and 9 respectively. Four patients were relisted, because of HCC diagnosis in 1 case and 3 patients developed ascites. One further patient died (2.4%) because of rapidly progressing hepatocellular carcinoma twenty-two months after delisting. Of the 70 patients who received a liver graft, 9 died (13%). CONCLUSIONS: Antiviral therapy allows for a long-term improvement of liver function and the delisting of one-third of treated patients with risk of liver-related complications after delisting being very low.
BACKGROUNDS & AIMS: Treating patients with decompensated cirrhosis with direct-acting antiviral (DAA) therapy while on the waiting list for liver transplantation results in substantial improvement of liver function allowing 1 in 4 patients to be removed from the waiting list or delisted, as reported in a previous study promoted by the European Liver and Intestine Transplant Association (ELITA). The aim of this study was to report on clinical outcomes of delisted patients, including mortality risk, hepatocellular carcinoma development and clinical decompensation requiring relisting. METHODS: One hundred and forty-two HCV-positive patients on the liver transplant waiting list for decompensated cirrhosis, negative for hepatocellular carcinoma, between February 2014 and June 2015 were treated with DAA therapy and were prospectively followed up. RESULTS: Forty-four patients (30.9%) were delisted following clinical improvement. This percentage was higher than in the original study because of a number of patients being delisted long after starting DAAs. The median Child-Pugh and MELD score of delisted patients was 5.5 and 9 respectively. Four patients were relisted, because of HCC diagnosis in 1 case and 3 patients developed ascites. One further patient died (2.4%) because of rapidly progressing hepatocellular carcinoma twenty-two months after delisting. Of the 70 patients who received a liver graft, 9 died (13%). CONCLUSIONS: Antiviral therapy allows for a long-term improvement of liver function and the delisting of one-third of treated patients with risk of liver-related complications after delisting being very low.
Authors: Nicholas F Parrish; Irene D Feurer; Lea K Matsuoka; Scott A Rega; Roman Perri; Sophoclis P Alexopoulos Journal: Transplant Direct Date: 2019-02-20
Authors: Sara Cuesta-Sancho; Mercedes Márquez-Coello; Francisco Illanes-Álvarez; Denisse Márquez-Ruiz; Ana Arizcorreta; Fátima Galán-Sánchez; Natalia Montiel; Manuel Rodriguez-Iglesias; José-Antonio Girón-González Journal: World J Hepatol Date: 2022-01-27