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

Nabatchikova, Ekaterina; Abdurakhmanov, Dzhamal; Rozina, Teona; Nikulkina, Elena; Tanaschuk, Elena; Moiseev, Sergey

doi:10.1016/j.clinre.2021.101714

Cited by 10 publications

(3 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A successful therapy of the underlying liver disease aetiology has been shown to not only induce regression of fibrosis 19 and portal hypertension 30,31 but also to improve liver function and to enable the delisting of a subset of decompensated liver transplant candidates. 21,22,24,32 These observations have challenged the irreversibility of dACLD and have led to the introduction of novel criteria for the definition of hepatic recompensation by the Baveno VII faculty. 25 However, recompensation criteria were primarily developed based on clinical observations from viral hepatitis and ALD, 32,33 while other aetiologies, for which the exact criteria required for an aetiological cure are less well defined, were formally excluded.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…19 On a smaller scale, similar results have been shown for patients with PBC receiving UDCA ± bezafibrate. 20 Putting these findings into context with other studies showing that transplant candidates who achieve significant clinical and biochemical improvements following a successful aetiological therapy may eventually be delisted, [21][22][23][24] the Baveno VII faculty proposed the concept of hepatic recompensation. 25 However, as the current definition of hepatic recompensation is limited to patients with ALD and hepatitis B or C, insights into other liver disease aetiologies, particularly PBC as the leading cholestatic disorder, are still lacking.…”

Section: Introductionmentioning

confidence: 87%

See 2 more Smart Citations

Evaluation of potential hepatic recompensation criteria in patients with PBC and decompensated cirrhosis

Hofer,

Burghart,

Halilbasic

et al. 2024

Aliment Pharmacol Ther

View full text Add to dashboard Cite

SummaryBackgroundAetiological therapy improves liver function and may enable hepatic recompensation in decompensated cirrhosis.AimsWe explored the potential for recompensation in patients with decompensated primary biliary cholangitis (PBC) – considering a biochemical response to ursodeoxycholic acid (UDCA) according to Paris‐II criteria as a surrogate for successful aetiological treatment.MethodsPatients with PBC were retrospectively included at the time of first decompensation. Recompensation was defined as (i) resolution of ascites and hepatic encephalopathy (HE) despite discontinuation of diuretic/HE therapy, (ii) absence of variceal bleeding and (iii) sustained liver function improvement.ResultsIn total, 42 patients with PBC with decompensated cirrhosis (age: 63.5 [IQR: 51.9–69.2] years; 88.1% female; MELD‐Na: 13.5 [IQR: 11.0–15.0]) were included and followed for 41.9 (IQR: 11.0–70.9) months after decompensation. Seven patients (16.7%) achieved recompensation. Lower MELD‐Na (subdistribution hazard ratio [SHR]: 0.90; p = 0.047), bilirubin (SHR per mg/dL: 0.44; p = 0.005) and alkaline phosphatase (SHR per 10 U/L: 0.67; p = 0.001) at decompensation, as well as variceal bleeding as decompensating event (SHR: 4.37; p = 0.069), were linked to a higher probability of recompensation. Overall, 33 patients were treated with UDCA for ≥1 year and 12 (36%) achieved Paris‐II response criteria. Recompensation occurred in 5/12 (41.7%) and in 2/21 (9.5%) patients with vs. without UDCA response at 1 year, respectively. Recompensation was linked to a numerically improved transplant‐free survival (HR: 0.46; p = 0.335). Nonetheless, 4/7 recompensated patients presented with liver‐related complications after developing hepatic malignancy and/or portal vein thrombosis and 2 eventually died.ConclusionsPatients with PBC and decompensated cirrhosis may achieve hepatic recompensation under UDCA therapy. However, since liver‐related complications still occur after recompensation, patients should remain under close follow‐up.

show abstract