SNFGE SNFGE
 
Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
 
 
Journal of Hepatology
  2018/07  
 
  2018 Jul;69(1):11-17.  
  doi: 10.1016/j.jhep.2018.02.012  
 
  The efficacy of direct anti-HCV drugs improves early post-liver transplant survival and induces significant changes in waiting list composition  
 
  Crespo G, Trota N, Londoño MC, Mauro E, Baliellas C, Castells L, Castellote J, Tort J, Forns X, Navasa M  
  https://www.ncbi.nlm.nih.gov/pubmed/29481821  
 
 

Abstract
 

BACKGROUND & AIMS:

The efficacy of direct-acting antivirals (DAAs) has dramatically changed the prognosis of patients with chronic hepatitis C. We aimed to evaluate the impact of DAA therapy on the composition of the liver transplant (LT) waiting list and the early post-transplant survival.

METHODS:

We evaluated all patients admitted to the waiting list for a primary LT between 1st January 2008 and 31st of December 2016 in Catalonia, Spain. Time span was divided into two periods according to the availability of different antiviral therapies: 2008-2013 (interferon-based therapies) and 2014-2016 (DAA). Changes in the indications of LT and the aetiology of liver disease, as well as post-LT patient survival, were evaluated according to the year of inclusion and transplantation, respectively.

RESULTS:

We included 1,483 patients. Admissions in the waiting list for hepatitis C virus (HCV)-related liver disease decreased significantly, from 47% in 2008-2013 to 35% in 2014-2016 (p <0.001), particularly because of a reduction in patients with decompensated cirrhosis. In contrast, NASH-related inclusions increased from 4% to 7% (p = 0.003). Three-year post-LT patient survival increased significantly in the second period in the whole cohort (82% vs. 91%, p = 0.002), because of better survival in anti-HCV positive patients (76% vs. 91%, p = 0.001), but not in anti-HCV negative patients (88% vs. 91% p = 0.359). Anti-HCV positive serology, the time period of 2008-2013 and higher donor age were independently associated with post-LT mortality in the whole cohort; while time period and donor age were independently associated with post-LT mortality in anti-HCV positive recipients.

CONCLUSIONS:

The high efficacy of DAAs is associated with significant changes in the composition of the LT waiting list and, more importantly, results in improved post-transplant survival.

LAY SUMMARY:

The efficacy of the new direct-acting antivirals is associated with a significant improvement in survival of patients undergoing liver transplantation because of hepatitis C virus-related liver disease. In addition, it has decreased the number of patients with hepatitis C that need a liver transplant.

 
Question posée
 
L'efficacité des médicaments anti-VHC directs (AAD) améliore la survie précoce des transplantations post-hépatiques (TH) et induit des changements significatifs dans la composition des listes d'attente.
 
Question posée
 
L'efficacité élevée des AAD est associée à des changements significatifs dans la composition de la liste d'attente de la TH et entraîne une amélioration de la survie après la transplantation.
 
Commentaires

Très beau travail collaboratif espagnol portant sur près de 1500 patients, confirmant la révolution thérapeutique apportée par les AAD.

 
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