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Clinical outcomes of patients undergoing antiviral therapy while awaiting liver transplantation

Pascasio JM (1), Vinaixa C (2), Ferrer MT (1), Colmenero J (3), Rubin A (2), Castells L (4), Manzano ML (5), Lorente S (6), Testillano M (7), Xiol X (8), Molina E (9), González-Diéguez L (10), Otón E (11), Pascual S (12), Santos B (4), Herrero JI (13), Salcedo M (14), Montero JL (15), Sánchez-Antolín G (16), Narváez I (17), Nogueras F (18), Giráldez Á (1), Prieto M (2), Forns X (3), Londoño MC (19). (1) UGC Digestive Diseases, Hospital Universitario Virgen del Rocío, IBIS, CIBERehd, Sevilla, Spain.
(2) Liver Unit, Digestive Medicine Service, Hospital Universitario La Fé, CIBERehd, Valencia, Spain.
(3) Liver Unit, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain.
(4) Internal Medicine Service, Hospital Universitari Vall d'Hebron, CIBERehd, Barcelona, Spain.
(5) Digestive Diseases Service, Hospital Universitario 12 Octubre, Madrid, Spain.
(6) Liver Transplant Unit, Digestive Diseases Service, Hospital Universitario Lozano Blesa, Zaragoza, Spain.
(7) Liver Unit, Digestive Diseases Service, Hospital Universitario Cruces, Vizcaya, Spain.
(8) Digestive Diseases Service, Hospital Universitari Bellvitge, Barcelona, Spain.
(9) Abdominal Transplant Unit, CHU Santiago de Compostela, IDIS, Santiago, Spain.
(10) Liver Unit, Hospital Universitario Central de Asturias, Asturias, Oviedo, Spain.
(11) Digestive Diseases Service, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain.
(12) Liver Unit, Hospital General Universitario, CIBERehd, Alicante, Spain.
(13) Liver Unit, Clínica Universitaria de Navarra, CIBERehd, IdiSNA, Pamplona, Spain.
(14) Liver Transplant Unit, Hospital General Universitario Gregorio Marañón, CIBERehd, Madrid, Spain.
(15) UGC Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, Spain.
(16) Liver Transplant Unit, Hospital Universitario Río Ortega, Valladolid, Spain.
(17) Digestive Diseases Service, Hospital Universitario Infanta Cristina, Badajoz, Spain.
(18) Digestive Diseases Service, Hospital Universitario Virgen de las Nieves, Granada, Spain.
(19) Liver Unit, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain

Revisão:Journal of Hepatology

Data: 22/Ago/2017

Hepatologia

BACKGROUND & AIMS:
Antiviral therapy against hepatitis C (HCV) infection has proved to be safe and efficacious in patients with cirrhosis awaiting liver transplantation (LT). However, the information regarding the clinical impact of viral eradication on the waiting list is still limited.

The aim of the study was to investigate the probability of delisting in patients who underwent antiviral therapy and the clinical outcomes delisted patients.

METHODS:
Observational, multicenter and retrospective analysis of prospectively collected data of HCV-positive patients treated with an interferon-free regimen while awaiting LT in 18 hospitals in Spain.

RESULTS:
238 patients were enrolled in the study. The indication for LT was decompensated cirrhosis in 171 (72%) patients (with [n=49] or without [n=122] hepatocellular carcinoma [HCC]), and HCC with compensated cirrhosis in 67 (28%) patients.

Sustained virological response (SVR) rate was significantly higher in patients with compensated cirrhosis and HCC with 92% versus 83% in patients with decompensated cirrhosis with or without HCC (p=0.042).

Among 122 patients with decompensated cirrhosis without HCC, 29 (24%) were delisted due to improvement. No patient with baseline MELD score > 20 was delisted. After delisting (median follow-up of 88 weeks), 3 had clinical decompensations and 3 had de novo HCC. Two of the 3 patients with HCC were re-admitted to the waiting list while one patient received definite treatment with radiofrequency. All 3 patients with decompensation (variceal bleeding and mild ascites) were resolved by medical treatment. The remaining 23 patients had no decompensation events and no HCC.

CONCLUSIONS:
Antiviral therapy is safe and efficacious in patients awaiting LT. A quarter of patients with decompensated cirrhosis can be delisted due to clinical improvement, which appears to be stable in most of them. Thus, delisting is a safe strategy that could spare organs and benefit patients with a more urgent need.

LAY SUMMARY:
Antiviral therapy in patients awaiting liver transplantation is safe and efficacious. Viral eradication allows removal from the waiting list of a quarter of treated patients. Delisting due to improvement is a safe strategy that saves organs to most needed patients.

CITAÇÃO DO ARTIGO  J Hepatol. 2017 Aug 22. pii: S0168-8278(17)32215-8. doi: 10.1016/j.jhep.2017.08.008

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