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Abstract Details
Outcomes in Hepatitis C Positive Liver Transplantation: Timing of Direct-Acting Antiviral Treatment and Impact on Graft Fibrosis
Jennifer Wellington1, Andrew Ma2, Shyam Kottilil3, Bharath Ravichandran4, Jennifer Husson3, David Bruno5, Eleanor Wilson3
Author information
1Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
2Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
3Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
4Department of Pharmacy, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
5Division of Transplant Surgery, University of Maryland Medical Center, Baltimore, MD 21201, USA.
Abstract
Liver transplantation for hepatitis C virus (HCV)-related disease has the lowest five-year graft survival among all liver transplant recipients. Graft failure due to accelerated fibrosis from unrestrained HCV replication is common. Optimal timing of HCV treatment with direct-acting antiviral agents remains unknown. We compared HCV liver transplant recipients successfully treated for HCV before transplant to those treated within 1 year of transplant to determine if graft fibrosis, measured by Fib-4 scores, differs with timing of treatment. Fib-4 scores less than or equal to 1.45 defined minimal fibrosis and greater than 1.45 defined greater than minimal fibrosis. We identified 117 liver transplant recipients: 52 treated before transplantation and 65 treated within 1 year of transplantation. Overall, 34% of recipients had minimal fibrosis, and the likelihood of having minimal fibrosis following treatment and liver transplantation did not differ by timing of treatment. The odds ratio of having greater than minimal fibrosis was 0.65 (95% CI 0.30, 1.42) among those treated within 1 year after transplantation compared to those treated before transplantation (p-value 0.28). Importantly, nearly 2/3 of these patients had evidence of fibrosis progression one year after sustained virologic response, supporting recommendations for early antiviral-based treatment to prevent accumulation of HCV-related disease.