Delisting of Liver Transplant Candidates with Chronic HCV Infection after Viral Erradication: Outcome 2 Years after Delisting. A European Study

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European Liver and Intestine Transplant Association (ELITA).Background and AimsWe showed in a previous ELITA study that second generation Direct Acting Antivirals (DAAs) can lead to a significant clinical improvement of patients listed for liver transplantation (LT) due to decompensated cirrhosis and that 1 patient out of 4 could be removed from the waiting list (“delisted”). The objective of this study is to describe the clinical outcomes 2 years after delisting with particular attention to the risks of death, development of HCC and further re-deterioration.MethodsBetween February 2014 and June 2015, 142 HCV positive-patients listed for decompensated cirrhosis without hepatocellular carcinoma (HCC) were treated with DAA. Delisted patients were followed up until November 2017 regularly with liver function tests and abdominal ultrasounds.ResultsForty-two patients (29,6%) were delisted due to clinical improvement after a median follow up of 52 months from start of therapy. Median Child-Pugh and MELD scores at start of DAA therapy were 9 and 14, respectively. The median median follow up from delisting is now 105 weeks (74-148). One patient died (2.4%) 22 months after delisting due to a rapidly progressing HCC; two patients developed a single nodule of HCC and were re-listed; two other patients re-decompensated and were also relisted. The median Child-Pugh and MELD score of the 37 “still delisted” patients is 5.5 and 9 respectively.ConclusionsAfter a median follow up of 105 weeks (26 months) from delisting, the outcome of delisted patients is favorable. Longer follow up is needed to confirm these positive outcomes.

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