Liver Transplant Listing for Hepatitis C-associated Cirrhosis and Hepatocellular Carcinoma has Fallen in the United Kingdom Since the Introduction of Direct-acting Antiviral Therapy

Arash Vaziri; Alexander Gimson; Kosh Agarwal; Mark Aldersley; Andrew Bathgate; Douglas MacDonald; Stuart McPherson; David Mutimer; William Gelson

Disclosures

J Viral Hepat. 2019;26(2):231-235. 

In This Article

Abstract and Introduction

Abstract

Following the introduction of direct-acting antivirals (DAA), there have been reports of declining incidence of hepatitis C (HCV)-related liver disease as a liver transplantation indication. In this study, we assessed the impact of DAA on liver transplant indications in the UK and waiting list outcomes for patients with HCV. We assessed UK adult elective liver transplant registrants between 2006 and 2017. The aetiology of liver disease at registration was reclassified using an accepted hierarchical system and changes were assessed over time and compared before and after the introduction of DAA. Registration UKELD scores and 1-year waiting list outcomes were also compared. The proportion of waiting list patients registered with HCV-related cirrhosis reduced after the introduction of DAA from 10.5% in 2013 to 4.7% in 2016 (P < 0.001). Alcohol-related liver disease (ARLD) was the leading indication for liver transplantation followed by liver cancer (26.1% and 18.4% in 2016, respectively). The proportion of registrations with Hepatocellular carcinoma (HCC) associated with HCV reduced from 46.4% in 2013 to 33.7% in 2016 (P = 0.002). For patients with HCV-related cirrhosis at one year the outcomes of death, transplantation, delisting due to improvement or deterioration and awaiting a graft at 1 year were similar. For patients with HCV-related HCC, the proportion dying at 1 year reduced significantly from 2.9% to 0.0% (P = 0.04). These data demonstrate an association between DAA and reduced listing rates for HCV-related cirrhosis and HCC, but no significant changes in waiting list outcomes other than reduced mortality in the HCC group.

Introduction

It is estimated that 221 000 people are infected with hepatitis C (HCV) in the United Kingdom (UK).[1] HCV has been reported as the most common indication for liver transplantation in the United States (US) and Western Europe.[2] HCV treatment has evolved rapidly with sequential approval of multiple highly effective direct-acting antiviral (DAA) agents over the last 4 years.[3] The early access programme of DAA treatment commenced in the UK in 2014, and it has been reported that 9% of patients with HCV in the UK have now been treated.[3,4] Data from the UK in this cohort has shown improvement in MELD score and a reduction in episodes of decompensation.[3] Recent publications reviewing the US liver transplant waiting list database have reported a declining incidence of HCV-related liver disease as an indication for liver transplantation to the point where it is no longer the most common.[2,5]

In this study, we sought to assess the impact of DAA therapy on the indications for liver transplantation in the UK. We also assessed whether the outcomes for patients listed for HCV-related liver cirrhosis changed following the introduction of DAA therapy.

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