The use of direct-acting antivirals (DAA) is associated with significant improvements in survival in patients undergoing liver transplantation because of hepatitis C virus (HCV)-related liver disease and decreased the number of patients with HCV needing liver transplantation, according to a study published in the Journal of Hepatology.

Researchers in Spain evaluated 1,483 patients admitted to the waiting list for a primary liver transplant between January 1, 2008, and December 31, 2016, to determine the impact of DAA therapy (2014-2016) compared with interferon-based therapies (2008-2013) on the composition of the liver transplant waiting list and on early posttransplant survival.

They found that admissions to the liver transplant waiting list resulting from HCV-related liver disease decreased significantly from 47% in 2008 to 2013 to 35% in 2014 to 2016 (P <.001). This was attributed to fewer patients with decompensated cirrhosis, although there was an increase in nonalcoholic steatohepatitis-related inclusions from 4% to 7% (P =.003).

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In addition, 3-year post-liver transplant patient survival increased significantly in anti-HCV-positive patients from 2008 to 2013 to 2014 to 2016 (76% vs 91%; P =.001) but not in anti-HCV-negative patients (88% vs 91%; P =.359).

Overall, anti-HCV-positive serology, the time period from 2008 to 2013, and higher donor age were independently associated with post-liver transplant mortality.

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“In conclusion, we have demonstrated for the first time that the availability of DAA is associated with significant improvements in survival after liver transplantation in HCV-infected liver transplant candidates. Considering the tremendous impact of HCV recurrence in the results of liver transplant, it is clear that DAA will dramatically change the scenario of liver transplantation, probably contributing also to long-term improvements in survival,” stated the authors.


Crespo G, Trota N, Londoño MC, et al. The efficacy of direct anti-HCV drugs improves early post-liver transplant survival and induces significant changes in wait-list composition [published online February 23, 2018]. J Hepatol. doi: 10.1016/j.jhep.2018.02.012