Impact of Hepatitis C Virus (HCV) Antiviral Treatment on the Need for Liver Transplantation (LT)

Esteban Sáez-González; Carmen Vinaixa; Fernando San Juan; Vanesa Hontangas; Salvador Benlloch; Victoria Aguilera; Angel Rubín; María García; Martín Prieto; Rafa López-Andujar; Marina Berenguer


Liver International. 2018;38(6):1022-1027. 

In This Article

Patients and Methods

Study Design

A population–based cohort study was performed based on the registry of LT patients of La Fe University Hospital in Valencia, a prospectively maintained registry. Data from patients included in the LT WL over the last 20 years (from 1997 to 2016) were obtained, and divided in different time periods for their comparison. We identified three eras in the HCV treatment: interferon (IFN)–based regimens (1997–2009), triple therapy with first–generation protease inhibitors–PI–(2010–2013) and all–oral DAA regimens (2014–2016). The variables collected were the following: demographic (age, sex, MELD score), inclusion date in the WL, date of withdrawal from the WL, reason to exit the WL (LT, death or delisting due to the progression of the underlying process and/or development of a condition considered an absolute contraindication for LT or delisting due to clinical improvement), indications of LT (decompensated cirrhosis, HCC), and specific etiologies (HCV, alcohol, mixed, others). In case of clinical improvement due to HCV therapy, the following definition was used: delisted: patient is off the list because a durable clinical improvement is verified based on the clinical judgement of the physician.[17] Patients were classified as being listed for indication of decompensated cirrhosis if their MELD at LT listing was≥15 or they had complications such as refractory ascites, hepatic hydrothorax, severe or chronic hepatic encephalopathy and/or hepato–pulmonary syndrome. On the other hand, patients were classified as being WL for the indication of HCC if HCC was identified as the listing indication in patients with cirrhosis. The study was approved by the ethical committee of our hospital: Clinical Research Ethics Committee (CEIC), Medical Research Institute of the Hospital La Fe (IIS La Fe).

Statistical Analysis

A descriptive statistical analysis was performed in which data were expressed as mean and standard deviation or median and IQR. The categorical variables were compared with the chi–squared test or two–sided Fisher's exact test; continuous variables were analyzed by Student's t–test or by Wilcoxon's rank–sum test, as appropriate. A P value of less than .05 was considered significant.