Delisting and clinical outcomes of liver transplant candidates after hepatitis C virus eradication: A long-term single-center experience.

BACKGROUND: Previous short-term studies have reported on liver function improvements and delisting among liver transplantation (LT) candidates with hepatitis C virus (HCV) and decompensated liver cirrhosis after successful antiviral therapy. This study aimed to evaluate the long-term impact of HCV eradication on liver function, portal hypertension, probability of delisting, and clinical outcomes in patients awaiting LT. METHODS: Forty-five LT candidates with decompensated HCV cirrhosis were prospectively observed after HCV eradication by direct-acting antiviral therapy. The median follow-up (FU) time was 24 months. RESULTS: Twenty-six (57.8%) patients were delisted due to clinical improvement. Multivariate analysis revealed male gender (hazard ratio (HR) 3.28; p = 0.022), baseline Child - Turcotte - Pugh class C (HR 4.81; p = 0.003), and delta prothrombin index <2% between baseline and the time of sustained virological response (HR 3.82; p = 0.01) as independent risk factors for non-delisting. During a median FU of 21 months after delisting, hepatocellular carcinoma (HCC) developed in 2 (7.7%) patients. Among non-delisted patients, HCC developed in 6 (31.6%) cases, variceal bleeding developed in 3 (15.8%) patients, and spontaneous bacterial peritonitis developed in 2 (10.5%) patients. CONCLUSION: HCV eradication lead to the delisting of more than 50% of patients, but did not eliminate the HCC risk, and close monitoring of patients should continue after the end of treatment.

Sofosbuvir-based salvage therapy for HCV infection in cirrhotic patients with DAA failure and multidrug resistance.

Despite very high efficacies of direct-acting antivirals (DAAs) reported in clinical trials, treatment failure in real-life practice can occur in 5-10% of cases and is mostly associated with emergence of resistance-associated substitutions (RASs). Little is known about the efficacy of retreatment in these patients, especially in those with decompensated cirrhosis, and only a few retreatment studies have been performed so far. Here we present case reports of successful sofosbuvir-based treatment in patients with advanced class B cirrhosis with prior pegylated interferon/ribavirin and all-oral DAA failure with multiclass drug resistance. HCV resistance testing at failure was performed to guide the choice of salvage therapy.