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Thématique :
- Foie
Originalité :
Très original
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2018/06  
 
  2018 Jun;67(6):2085-2095.  
  doi: 10.1002/hep.29723.  
 
  Transplanting hepatitis C virus-positive livers into hepatitis C virus-negative patients with preemptive antiviral treatment: A modeling study.  
 
  Chhatwal J, Samur S, Bethea ED, Ayer T, Kanwal F, Hur C, Roberts MS, Terrault N, Chung RT  
  https://www.ncbi.nlm.nih.gov/pubmed/29222916  
 
 

Abstract

Under current guidelines, hepatitis C virus (HCV)-positive livers are not transplanted into HCV-negative recipients because of adverse posttransplant outcomes associated with allograft HCV infection. However, HCV can now be cured post-LT (liver transplant) using direct-acting antivirals (DAAs) with >90% success; therefore, HCV-negative patients on the LT waiting list may benefit from accepting HCV-positive organs with preemptive treatment. Our objective was to evaluate whether and in which HCV-negative patients the potential benefit of accepting an HCV-positive (i.e., viremic) organ outweighed the risks associated with HCV allograft infection. We developed a Markov-based mathematical model that simulated a virtual trial of HCV-negative patients on the LT waiting list to compare long-term outcomes in patients: (1) willing to accept any (HCV-negative or HCV-positive) liver versus (2) those willing to accept only HCV-negative livers. Patients receiving HCV-positive livers were treated preemptively with 12 weeks of DAA therapy and had a higher risk of graft failure than those receiving HCV-negative livers. The model incorporated data from published studies and the United Network for Organ Sharing (UNOS). We found that accepting any liver regardless of HCV status versus accepting only HCV-negative livers resulted in an increase in life expectancy when Model for End-Stage Liver Disease (MELD) was ≥20, and the benefit was highest at MELD 28 (0.172 additional life-years). The magnitude of clinical benefit was greater in UNOS regions with higher HCV-positive donor organ rates, that is, Regions 1, 2, 3, 10, and 11. Sensitivity analysis demonstrated that model outcomes were robust.

CONCLUSION:

Transplanting HCV-positive livers into HCV-negative patients with preemptive DAA therapy could improve patient survival on the LT waiting list. Our analysis can help inform clinical trials and minimize patient harm. (Hepatology 2018;67:2085-2095).

 

 
Question posée
 
Evaluation si et chez quel patient sans infection VHC il existe un bénéfice potentiel à accepter un organe VHC positif (i.e., virémique) en pesant les risques associés à une infection par le VHC de l’allogreffe à partir d’un modèle de Markov qui simule une étude virtuelle de patients VHC négatifs sur liste d’attente de transplantation hépatique visant à comparer le pronostic à long terme des patients (1) chez qui le foie est accepté quelque soit le statut (VHC-négatif ou VHC-positif) versus (2) chez le fois est accepté seulement si VHC négatif.
 
Question posée
 
Ce modèle mathématique montre qu’accepter un foie quelque soit son statut VHC augmente l’espérance de vie des patients en attente de transplantation hépatique quand le MELD >20 avec un bénéfice le plus élevé si le MELD est à 28 (0,172 année de vie en plus).
 
Commentaires

A méditer rapidement pour application dans la vraie vie.

 
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