To study the changes in liver function and portal hypertension, and clinical outcomes after elimination of hepatitis C virus (HCV) by direct-acting antiviral agents in patients awaiting an orthotopic liver transplantation (OLT).
Material and methods
We evaluated liver function, portal hypertension, Child-Turcotte-Pugh (CTP) and models of end-stage liver disease (MELD) scores, and life-threatening complications every 3-6 months after antiviral therapy in 45 patients with decompensated liver cirrhosis (LC) awaiting an OTP. Patients were excluded from the waiting list (delisting) in the case of LC compensation and MELD <15 points. The median follow-up time was 24 (12; 27) months.
During follow-up, the MELD score decreased from 16 to 13 points (p<0.001), and the CTP score decreased from 8 to 7 points (p<0.001). Twenty-six (57.8%) patients were excluded from the waiting list. Male gender (risk ratio [HR] 3.28; p=0.022), baseline CTP class C (HR 4.81; p=0.003) and changes in prothrombin index <2% at the time of sustained virological response (HR 3.82; p = 0.01) were independent factors associated with the absence of delisting. HCC developed in 2 (7.7%) delisted patients. Among non-delisted patients, hepatocellular carcinoma (HCC) developed in 6 (31.6%) cases, variceal bleeding in 3 (15.8%) cases, spontaneous bacterial peritonitis in 2 (10.5%) cases.
HCV eradication in patients with decompensated LC waiting for OLT results in an improvement of liver function parameters, portal hypertension and delisting of above 50% of them. After delisting, the risk of HCC is reduced, but not completely eliminated, that necessitates lifelong follow-up.
Hepatitis C virus, liver transplantation, liver cirrhosis, direct-acting antiviral agents, sustained virologic response.