DAA therapy and long-term hepatic function in advanced/decompensated cirrhosis: Real-world experience from HCV-TARGET cohort.

Abstract Background and Aims Direct-acting antiviral (DAA) HCV therapy is used in decompensated cirrhosis with the expectation of improvement in hepatic function. Little is known about the long-term benefit of successful treatment. Methods Patients with advanced/decompensated cirrhosis (MELD ≥10) in HCV-TARGET who initiated NS5A-containing DAA therapy prior to September, 2018, were included. Treatment outcomes and the impact of treatment on short-term and long-term hepatic function were examined. Results 642 patients were analyzed. The mean age was 60 years, 68% were male. The median baseline MELD was 12 (range 10-39) and 64% had prior decompensation. Among patients with available virologic outcomes, 90.5% achieved SVR12. Twenty-four % achieved a clinically significant decrease in MELD by ≥3 points during short term follow-up (9-26 weeks after the end of treatment). However, in long-term follow up (median of 4 years after treatment), mean changes in MELD (-0.30 points), total bilirubin (+0.23 mg/dl) and albumin (+0.36 g/dl) were marginal. Fifty-one patients died and 22 underwent liver transplant. In long term follow up, a clinically meaningful decrease in MELD of ≥3 occurred in 29% and a final MELD score of Conclusion In a large real-world experience of patients with advanced/decompensated HCV cirrhosis treated with DAA, there were only marginal improvements in MELD, total bilirubin, or albumin in long-term follow up (median of 4 years after treatment) after achieving SVR; a clinically meaningful decrease in MELD of ≥3 occurred in 29% and a final MELD score of