Delisting of Liver Transplant Candidates with Chronic HCV Infection after Viral Erradication: Outcome 2 Years after Delisting. A European Study
Carmen Vinaixa1, Luca Saverio Belli2, Marina Berenguer1, Pablo Cortesi3, Mario Strazzabosco2, Rita Faccheti3, Susanne-Rasoul Rockenschaub6, Silvia Martini7, Cristina Morelli8, Francesca Donato9, Ricardo Volpes5, Luisa Pasulo12, Georges-Philippe Pageaux10, Audrey Coilly11, Giovanni Perricone3, Chiara Mazzarelli2, Stella Di Nicola3, Gabriela Berlakovich6, Christophe Duvuox13.
1Hepatology andLiver Transplantation Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain; 2Department of Gastroenterology and Hepatology. Liver Unit., Niguarda Hospital, Milan, Italy; 3Research Center on Public Health (CESP), University of Milan-Bicocca, Milan, Italy; 4Digestive Disease Section and International Centre for Digestive Health, University of Milano Bicocca and Yale University Liver Center, Department of Medicine, New Haven, Italy; 5Mediterranean Institute for Transplant, Mediterranean Institute for Transplant, Palermo, Italy; 6Division of Transplantation, Department of Surgery, University of Vienna, Vienna, Italy; 7Gastro-Hepatology Unit. Liver Transplantation Center., Molinette Hospital. AOU Cittadella Salute e della Scienza di Torino, Turin, Italy; 8Liver and Multiorgan Transplantation, Sant Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; 9Division of Digestive Diseases, Maggiore University Hospital, Milan, Italy; 10Department of Hepatology, Gastroenterology and Liver Transplantation, Centre Hospitalier Universitarire (CHU) Saint Eloi, Montpellier, France; 11Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France; 12Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy; 13Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Paris-Est University, Creteil, France
European Liver and Intestine Transplant Association (ELITA).
Background and Aims: We showed in a previous ELITA study that second generation Direct Acting Antivirals (DAAs) can lead to a significant clinical improvement of patients listed for liver transplantation (LT) due to decompensated cirrhosis and that 1 patient out of 4 could be removed from the waiting list (“delisted”). The objective of this study is to describe the clinical outcomes 2 years after delisting with particular attention to the risks of death, development of HCC and further re-deterioration.
Methods: Between February 2014 and June 2015, 142 HCV positive-patients listed for decompensated cirrhosis without hepatocellular carcinoma (HCC) were treated with DAA. Delisted patients were followed up until November 2017 regularly with liver function tests and abdominal ultrasounds.
Results: Forty-two patients (29,6%) were delisted due to clinical improvement after a median follow up of 52 months from start of therapy. Median Child-Pugh and MELD scores at start of DAA therapy were 9 and 14, respectively. The median median follow up from delisting is now 105 weeks (74-148). One patient died (2.4%) 22 months after delisting due to a rapidly progressing HCC; two patients developed a single nodule of HCC and were re-listed; two other patients re-decompensated and were also relisted. The median Child-Pugh and MELD score of the 37 “still delisted” patients is 5.5 and 9 respectively.
Conclusions: After a median follow up of 105 weeks (26 months) from delisting, the outcome of delisted patients is favorable. Longer follow up is needed to confirm these positive outcomes.
