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

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Abstract

Background and Aims

We 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.

Methods

Between 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.

Results

Forty-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.

Conclusions

After 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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