Hepatitis C virus related cirrhosis decreased as indication to liver transplantation since the introduction of direct-acting antivirals: A single-center study

Table 1 Characteristics at waiting list registration between hepatitis C virus and non- hepatitis C virus patients

	HCV n = 490 (%)	Non-HCV n = 704 (%)	P value
Age (yr)	56 ± 7.8	55 ± 10	ns
Gender (male)	393 (80)	532 (75.5)	ns
BMI	25 ± 4	25 ± 4	ns
Blood group			ns
0	206 (42)	311 (44.2)
A	199 (40.6)	282 (40)
AB	19 (3.8)	30 (4.3)
B	66 (13.4)	81 (11.5)
HCC (yes)	303 (61.8)	295 (42)	0.001
Child-Pugh classes			0.04
A	137 (28)	163 (23)
B	185 (38)	252 (36)
C	168 (34)	289 (41)
MELD at WL registration	15 ± 6	16.7 ± 6.8	0.01

HCV: Hepatitis C virus; BMI: Body mass index; HCC: Hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease; WL: Waiting list.

Table 2 Characteristics of hepatitis C virus patients at waiting list registration before and after direct-acting antiviral introduction, according to indication to waiting list registration (decompensated liver disease or hepatocellular carcinoma)

	dec-HCV			HCV/HCC
	Pre-DAA n = 181 (%)	Post-DAA n = 70 (%)	P value	Pre-DAA n = 144 (%)	Post-DAA n = 94 (%)	P value
Gender (male)	139 (77)	53 (75.7)	ns	118 (82)	82 (87)	ns
Age (yr)	55 ± 8	55 ± 9	ns	57 ± 7	59 ± 6	0.03
BMI	25 ± 3	25 ± 4	ns	24.7 ± 3	25 ± 3.6	ns
Refractory ascites (yes)	74 (40)	32 (45.7)	ns	-	-
Blood group			ns			ns
0	86 (47.8)	32 (45.7)		62 (43)	35 (39)
A	70 (38.4)	25 (35.7)		52 (36)	42 (44)
AB	4 (2.2)	4 (5.7)		6 (4)	5 (5)
B	21 (11.5)	9 (12.8)		24 (17)	12 (12)
HCC (yes)	41 (22.5)	24 (34.2)	ns	-	-
Comorbidities			ns			ns
None	134 (74.1)	44 (62.8)		104 (72.2)	76 (80)
HBV	7 (3.8)	2 (2.8)		8 (5.5)	3 (3.2)
Alcohol	34 (18.6)	19 (27.1)		26 (18)	10 (10.6)
Metabolic	6 (3.2)	5 (7.3)		6 (4.3)	5 (5.3)
Child-Pugh classes			ns			0.01
A	6 (3.3)	3 (4.2)		64 (44.5)	64 (68)
B	67 (37)	25 (35.7)		67 (46.5)	26 (27)
C	108 (59.6)	42 (60)		13 (9)	4 (4)
MELD score	18.7 ± 6	19.3 ± 6	ns	11 ± 3.5	11 ± 3.4	ns
HCV Genotype1			ns			ns
1a	18 (15.1)	14 (23)		11 (10.2)	16 (18.8)
1b	68 (57.1)	34 (55.7)		67 (62)	39 (45.8)
2	12 (10)	3 (4.9)		10 (9.3)	4 (4.7)
3	16 (13.4)	6 (9.8)		15 (13.9)	22 (25.8)
4	5 (3.3)	4 (6.5)		5 (4.6)	4 (4.7)
SVR achievement
None	159 (87.8)	39 (55.7)		128 (89)	45 (47.8)
Before WL registration	13 (7.1)	17 (24.2)	0.004	10 (7)	24 (25.5)	0.001
IFN based	13 (7.1)	2 (2.8)		10 (7)	6 (6.3)
During WL registration	9 (4.9)	14 (20)	0.009	6 (4)	25 (26.5)	0.001

¹HCV genotype was available in 373 patients at the time of WL registration. HCV: Hepatitis C virus; HCC: Hepatocellular carcinoma; DAA: Direct-acting antivirals; BMI: Body mass index; HBV: Hepatitis B virus; MELD: Model of End-Stage Liver Disease; SVR: Sustained virological response; WL: Waiting list.

Table 3 Characteristics at the time of liver transplantation between hepatitis C virus and non-hepatitis C virus patients n (%)

	HCV n = 289	Non-HCV n = 377	P value
Age (yr)	57 ± 7.5	55 ± 10	0.02
Gender (male)	240 (83)	288 (76)	0.04
Blood group			ns
0	118 (40.8)	167 (44.2)
A	124 (43)	147 (39)
AB	12 (4.1)	19 (5)
B	35 (12.1)	44 (11.8)
Child-Pugh classes
A	82 (25)	84 (22.2)
B	99 (36.7)	116 (30.7)	0.03
C	108 (38.2)	177 (47)
MELD score	17 ± 8	19 ± 8	0.01
Waiting time (mo)	9.6 ± 12	10 ± 14	ns

HCV: Hepatitis C virus; MELD: Model of End-Stage Liver Disease.

Table 4 Characteristics of hepatitis C virus patients at liver transplantation before and after direct-acting antiviral introduction, according to indication to waiting list registration (decompensated liver disease or hepatocellular carcinoma) n (%)

	dec-HCV			HCV/HCC
	Pre-DAA n = 91	Post-DAA n = 51	P value	Pre-DAA n = 89	Post-DAA n = 58	P value
Gender (male)	74 (81)	40 (78.4)	ns	77 (86.5)	49 (84.5)	ns
Age (yr)	54.8 ± 8	56 ± 8	ns	57 ± 7	58 ± 7	ns
Refractory ascites (yes)	37 (40.6)	27 (53)	ns	-	-
Blood group			ns			ns
0	41 (45)	21 (41.7)		37 (41.5)	19 (32.7)
A	35 (38)	22 (43.3)		39 (43.8)	28 (54.9)
AB	3 (3.3)	3 (5.8)		4 (4.5)	2 (3.4)
B	12 (13)	5 (9.8)		9 (10.2)	9 (15.5)
HCC (yes)	19 (20.8)	19 (37.3)	0.04	-	-
Child-Pugh classes			ns			0.001
A	3 (3.2)	1 (1.9)		38 (42.6)	42 (72.4)
B	27 (29.6)	17 (33.3)		42 (47.2)	12 (20.6)
C	61 (67.1)	33 (64.7)		9 (10)	4 (6.8)
MELD at LT	24 ± 6.5	23 ± 7.5	ns	11.7 ± 4	11.2 ± 3	ns
SVR at time of LT (yes)	8 (8.8)	15 (29.4)	0.002	10 (11)	24 (41)	0.0001
SVR after IFN-based regimens	7 (7.6)	2 (3.9)		9 (10.1)	1 (1.7)
Waiting time (mo)	8.3 ± 12	10.6 ± 12	ns	9 ± 7.7	10 ± 11	ns

HCV: Hepatitis C virus; HCC: Hepatocellular carcinoma; DAA: Direct-acting antivirals; BMI: Body mass index; MELD: Model of End-Stage Liver Disease; LT: Liver transplantation; SVR: Sustained virological response.

Table 5 Characteristics of hepatitis C virus patients who achieved sustained virological response after treatment with direct-acting antivirals while in the waiting list n (%)

	SVR after DAA before the WL n = 34	SVR after DAA in the WL n = 54
Age (yr)	58 ± 8	57.7 ± 8
Gender (male)	25 (73.5)	43 (79.6)
dec-HCV (yes)	15 (44)	44 (44.4)
MELD score before treament	-	13 ± 5
HCV genotype
1a	6 (17.6)	6 (11)
1b	17 (50)	34 (63)
2	2 (5.8)	2 (3.7)
3	7 (20.5)	7 (13)
4	2 (5.8)	5 (9.3)
Treatment regimens
Sofosbuvir	4 (11.7)	27 (50)
Sofosbuvir/Ledipasvir	23 (67.6)	18 (33.3)
Sofosbuvir/Daclatasvir	3 (8.8)	3 (5.5)
Sofosbuvir/Simeprevir	1 (2.9)	4 (7.4)
Other	5 (14.7)	2 (3.7)
Ribavirin use (yes)	1 (2.9)	37 (68.5)
MELD score after treament	12.3 ± 4	13 ± 6
Outcome
Waiting for LT	16 (47)	6 (11)
Delisted	1 (2.9)	10 (18.5)
LT	10 (29.4)	28 (51.8)
Drop out	5 (14.7)	2 (3.7)
Dead	2 (5.8)	8 (14.8)

SVR: Sustained virological response; DAA: Direct-acting antivirals; HCV: Hepatitis C virus; MELD: Model of End-Stage Liver Disease; LT: Liver transplantation.