Published online Oct 14, 2018. doi: 10.3748/wjg.v24.i38.4403
Peer-review started: June 7, 2018
First decision: July 11, 2018
Revised: July 26, 2018
Accepted: August 1, 2018
Article in press: August 1, 2018
Published online: October 14, 2018
Processing time: 127 Days and 14 Hours
Hepatitis C virus (HCV)-related cirrhosis has been the first indication for liver transplantation in Western Countries in the last decades. Introduction of all-oral direct-acting antivirals (DAAs) significantly modified the natural history of HCV related liver disease.
Our study aimed at evaluating the change in waiting list registrations and in liver transplantation for HCV related cirrhosis after DAAs introduction.
To evaluate the outcome of patients with HCV related cirrhosis, listed for liver transplantation at Padua University Hospital between 2006 and 2017. Patients were further divided according to two different time periods (2006-2013 vs 2014-2017) and according to indication to liver transplantation (decompensated disease vs hepatocellular carcinoma).
The outcome of patients listed for liver transplantation (LT) for HCV related cirrhosis was retrospectively analysed using a prospectively updated database.
After DAAs introduction, HCV-related cirrhosis significantly decreased as indication to waiting list registration, especially among patients with decompensated disease. Considering liver transplantation, even HCV remained the most common indication to LT over time (289/666, 43.4%), there was a trend towards a decrease in the last time period (2013-2017). Furthermore, HCV patients who achieved viral eradication had better transplant-free survival than untreated HCV patients.
The study demonstrated that HCV related cirrhosis might be a decreasing indication to liver transplantation, especially for decompensated liver disease. Viral eradication achieved with DAA-based regimens should reduce decompensation rates and need to LT. This study confirmed what already known in literature about the beneficial role provided by DAAs in patients with HCV related cirrhosis. Viral eradication obtained after DAAs- based regimens should reduce decompensation rates amongst patients with HCV related cirrhosis. Future studies are needed to confirm the changing scenario regarding indications to LT in Western countries.
Viral eradication obtained after DAA therapy should reduce decompensation rates amongst patients with HCV related cirrhosis. To further investigate trends in waiting list registrations and liver transplantations for HCV related cirrhosis, especially in the setting of hepatocellular carcinoma. Larger, multicentre, prospective studies are the best methods for the future research.