Liver Transplantation for Hepatitis C Patients in the Era of Direct-Acting Antiviral Treatment: A Retrospective Cohort Study

Abstract Introduction Direct-acting antivirals (DAA’s) have revolutionized hepatitis-C virus (HCV) treatment, however controversy remains regarding timing of treatment in relation to liver-transplant (LT). Methods Single-center retrospective study assessing outcomes of listed HCV positive patients in the DAA-era (2014-2017). Patients treated with DAA’s before LT (DAA pre-LT) were compared to those who were not treated before LT (No DAA pre-LT) Results 156 HCV positive patients were listed during study-period;104 (67%) underwent LT while 52 (33%) were de-listed. Of transplanted patients, 48 (46%) received DAA pre-LT while 56 (54%) were treated post-LT. Both groups were comparable in age, gender, MELD, patient and graft survival and cure-rates (98% in DAA pre-LTvs.95% in No DAA pre-LT;p>0.05). DAA pre-LT group required higher number of treatments-per-patient to clear virus (1.46vs.1.06;p=0.0006), spent more time on waitlist (331d.vs150d;p=0.0040) and were less likely to receive livers from HCV positive donors (6%vs.25%;p=0.0148). Twenty-nine (56%) of the 52 delisted received DAA. They had lower listing-MELD (12vs.18;p=0.0033), and were more likely to be delisted for “condition improved” (34%vs.4%;p=0.0143) compared to the 23 (44%) delisted patients who did not receive DAA’s. Conclusions DAA’s were equally effective in clearing HCV in listed patients irrespective of timing. DAA pre-LT can disadvantage some patients through increase number of treatments needed and longer waitlist times, but treatment in some listed patients with low-MELD can improve condition and alleviate need for LT.