DAAs tied to drop in UK transplants for HCV cirrhosis, HCC

  • Vaziri A & al.
  • J Viral Hepat
  • 19 Oct 2018

  • curated by Yael Waknine
  • Univadis Clinical Summaries
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Takeaway

  • The introduction of direct-acting antivirals (DAAs) coincides with a decline in UK liver transplant (LT) waitlist rates for HCV-related cirrhosis and hepatocellular carcinoma (HCC).

Why this matters

  • The study quantifies qualitative reports of declining HCV-related liver disease.
  • The decline in HCC registrations further supports DAA safety.

Study design

  • Study of UK adults awaiting LT during 2006-2017.
  • Registrations after April 2014 were categorized as being in the DAA era, beginning with early-access programs.
  • Funding: None disclosed.

Key results

  • The proportion of patients waitlisted for HCV cirrhosis dropped after DAAs were introduced, from 10.5% in 2013 to 4.7% in 2016 (P<.001 style="list-style-type:circle;">
  • UK model for end-stage liver disease (UKELD) remained stable (55), suggesting no change in the threshold used for waitlisting.
  • The proportion of patients waitlisted for HCV-related HCC likewise dropped from 46.4% in 2013 to 33.7% in 2016 (P=.002).
  • In 2016, alcohol-related liver disease (26.1%) and liver cancer (18.4%; primarily HCC) were the most common indications for LT in 2016.
  • Waitlist outcomes at 1 year:
    • Cirrhosis: no significant change in proportion who died, underwent transplant, or were delisted.
    • HCC: significant decrease in 1-year mortality (2.9% vs 0.0%; P=.04); no change in number transplanted or delisted.
  • Limitations

    • Retrospective design.

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