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Thématique :
- Foie
Originalité :
Très original
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2017/03  
 
  2017 Mar;65(3):804-812  
  doi: 10.1002/hep.28923.  
 
  Reduction in liver transplant wait-listing in the era of direct-acting antiviral therapy.  
 
  Flemming JA, Kim WR, Brosgart CL, Terrault NA  
  https://www.ncbi.nlm.nih.gov/pubmed/28012259  
 
 

Abstract

Direct-acting antiviral (DAA) therapy, recently approved for patients with decompensated cirrhosis (DC) secondary to hepatitis C virus (HCV), is associated with improved hepatic function. We analyzed trends in liver transplant (LT) wait-listing (WL) to explore potential impact of effective medical therapy on WL registration. This is a cohort study using the Scientific Registry of Transplant Recipients database from 2003 to 2015. A total of 47,591 adults wait-listed for LT from HCV, hepatitis B virus (HBV), and nonalcoholic steatohepatitis (NASH) were identified. LT indication was defined as DC if the Model for End-Stage Liver Disease (MELD) at WL was ≥15 or hepatocellular carcinoma (HCC). Era of listing was divided into interferon (IFN; 2003-2010), protease inhibitor (PI; 2011-2013), and direct-acting antiviral (DAA; 2014-2015). Annual standardized incidence rates of WL were analyzed using Poisson regression. Adjusted incidences of LT WL for DC in HCV patients decreased by 5% in the PI era (P = 0.004) and 32% in the DAA era (P < 0.001) compared to the IFN era. Listing for DC in HBV also decreased in the PI (-17%; P = 0.002) and DAA eras (-24%; P < 0.001). Conversely, WL for DC in NASH increased by 41% in the PI era (P < 0.001) and 81% in the DAA era (P < 0.001). WL for HCC in both the HCV and NASH populations increased in both the PI and DAA eras (P < 0.001 for all) whereas HCC WL in HBV remained stable (P > 0.05 for all).

CONCLUSION:

The rate of LT WL for HCV complicated by DC has decreased by over 30% in the era of DAA therapy. Further reductions in WL are anticipated with increased testing, linkage to care, and access to DAA therapy. (Hepatology 2017;65:804-812).

 
Question posée
 
Avec l’arrivée des AVD du VHC, les inscriptions sur liste de transplantations hépatiques des patients VHC sont –elles modifiées en comparaison avec les patients sur liste pour NASH ou VHB ?
 
Question posée
 
Chez les patients cirrhotiques décompensés, diminution de 32% des patients VHC avec a contrario augmentation de 81% des NASH sur liste avec de plus une augmentation des patients avec carcinome hépatocellulaire qui est 4 fois plus présent en cas de NASH.
 
Commentaires

Le nombre de transplantations hépatiques ne va pas diminuer tout de suite !

 
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