Potential Liver Transplant Recipients with Hepatitis C: Should They Be Treated Before or After Transplantation?

Anand, Anil C.

doi:10.1016/j.jceh.2017.01.116

Cited by 12 publications

(7 citation statements)

References 89 publications

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“…There are several issues relevant to DAA therapy among patients with HCC. First, initial data suggested a potential increased risk of HCC recurrence, although subsequent studies did not support these findings . Second, in response to the controversy around HCC recurrence risk, the timing of DAA therapy in relation to HCC management became a point of debate .…”

Section: Introductionmentioning

confidence: 99%

“…First, initial data suggested a potential increased risk of HCC recurrence, [8][9][10][11][12][13][14] although subsequent studies did not support these findings. [15][16][17][18][19][20][21][22] Second, in response to the controversy around HCC recurrence risk, the timing of DAA therapy in relation to HCC management became a point of debate. [23][24][25] For example, some recommended DAA treatment deferral (ie at least 4-6 months) following potentially curative HCC management.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review with meta‐analysis: effectiveness of direct‐acting antiviral treatment for hepatitis C in patients with hepatocellular carcinoma

Lockart

Alavi

et al. 2019

Aliment Pharmacol Ther

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Summary Background Direct‐acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection is highly curative and tolerable. Among patients with hepatocellular carcinoma (HCC), optimal timing of DAA therapy remains unclear. Data on efficacy of DAA therapy in patients with HCC would inform this decision‐making. Aim To evaluate response to DAA therapy among patients diagnosed with HCV infection and HCC. Methods Bibliographic databases and conference abstracts were searched. Meta‐analysis was conducted to pool sustained virologic response (SVR) estimates. Results Fifty‐six studies with 5522 patients with HCV and HCC were included. Overall SVR was 88.3% (95% CI 86.1‐90.4). Twenty‐seven studies included patients with prior or present HCC (n = 3126) and patients without HCC (n = 49 138), in which SVR was 88.2% (95% CI 85.0‐91.4) and 92.4% (95% CI 91.1‐93.7) among patients with and without HCC, respectively (odds ratio: 0.54, 95% CI 0.43‐0.68, P < .001). In the subgroup analyses, higher SVR was seen in patients who received curative HCC management (SVR 90.4%, 95% CI 88.3‐92.4), or treated with sofosbuvir + NS5A inhibitor DAAs (SVR 96.9%, 95% CI 94.3‐99.4), or in patients with HCV genotype 1 infection (SVR 92.0%, 95% CI 88.1‐95.6). Conclusion Response to DAA therapy was lower in patients with HCC compared to those without HCC, regardless of cirrhosis status. Among HCC patients, there was an impact of proportion with curative HCC management on DAA therapy response.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Systematic review with meta‐analysis: effectiveness of direct‐acting antiviral treatment for hepatitis C in patients with hepatocellular carcinoma

Lockart

Alavi

et al. 2019

Aliment Pharmacol Ther

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“…Over the past 5 years, the nutritional status of patients with ESLD has become increasingly recognized as an important factor in outcomes. Despite increased weight and BMI, many obese individuals are nutritionally depleted, with muscle wasting and fatty muscle infiltration, which can lead to sarcopenic obesity[ 122 - 124 ]. Carey et al[ 125 ] performed a multicenter study to better define sarcopenia in LT, finding that skeletal mass index was independently associated with waitlist mortality and identifying cutoffs to define sarcopenia (< 50 cm 2 /m 2 for men and < 39 cm 2 /m 2 for women).…”

Section: Pre-transplant Considerations For Patients With Nashmentioning

confidence: 99%

Clinical considerations in the management of non-alcoholic steatohepatitis cirrhosis pre- and post-transplant: A multi-system challenge

Steggerda

Mahendraraj

Todo

et al. 2020

WJG

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Non-alcoholic steatohepatitis (NASH) is the most common chronic liver disease worldwide, and the fastest growing indication for liver transplantation in the United States. NASH is now the leading etiology for liver transplantation in women, the second leading indication for men, and the most common cause amongst recipients aged 65 years and older. Patients with end-stage liver disease related to NASH represent a unique and challenging patient population due the high incidence of associated comorbid diseases, including obesity, type 2 diabetes (T2D), and hypertension. These challenges manifest in the pre-liver transplantation period with increased waitlist times and waitlist mortality. Furthermore, these patients carry considerable risk of morbidity and mortality both before after liver transplantation, with high rates of T2D, cardiovascular disease, chronic kidney disease, poor nutrition, and disease recurrence. Successful transplantation for these patients requires identification and management of their comorbidities in the face of liver failure. Multidisciplinary evaluations include a thorough pre-transplant workup with a complete cardiac evaluation, control of diabetes, nutritional support, and even, potentially, consultation with a bariatric surgeon. This article provides a comprehensive review of the conditions and challenges facing patients with NASH cirrhosis undergoing liver transplantation and provides recommendations for evaluation and management to optimize them before liver transplantation to produce successful outcomes.

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“…In 2015, the Infectious Disease Society of America (IDSA) and American Association for the Study of Liver Diseases (AASLD) jointly published HCV treatment recommendations, detailing post‐LT treatment guidelines . These recommendations did not, however, directly address how, when, or which candidates LT centers should treat prior to LT, leading to varied opinions in the field . In 2017, the International Liver Transplantation Society (ILTS) expert consensus statements provided recommendations for the management of both HCV+ liver transplant candidates and recipients .…”

Section: Introductionmentioning

confidence: 99%

“…23 These recommendations did not, however, directly address how, when, or which candidates LT centers should treat prior to LT, leading to varied opinions in the field. 8,19,20,[24][25][26][27][28][29][30][31][32][33] In 2017, the International Liver Transplantation Society (ILTS) expert consensus statements provided recommendations for the management of both HCV+ liver transplant candidates and recipients. 34,35 Despite this rapidly changing landscape, few studies have directly examined the impact of DAAs on center-level attitudes and treatment decisions for LT patients.…”

mentioning

confidence: 99%

Changes in practice and perception of hepatitis C and liver transplantation: Results of a national survey

Shaffer

Thomas

Bowring

et al. 2018

Transplant Infectious Dis

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With new practice guidelines, it is important to understand how liver transplant (LT) centers have incorporated direct-acting antivirals (DAAs) into the management of hepatitis C virus-infected (HCV+) candidates and recipients. To explore how DAAs have affected LT centers’ willingness to treat HCV+ candidates and recipients and to use HCV+ donors, we surveyed high volume US LT centers (11/2014–12/2015) regarding practices for HCV+ candidates, recipients, and donors, before vs. after DAAs. We used the Scientific Registry of Transplant Recipients to compare centers’ number of LTs, HCV+ recipients, and HCV+ donors in the years before (1/1/2012–12/31/2013) and after (1/1/2016–12/31/2017) survey administration. Of 80 centers contacted, 57 (71%) responded, representing 69% of the total volume of LTs in 2013. After DAAs, most centers increased treating candidates with low (≤15) model for end-stage liver disease (MELD) (85.2%), intermediate/high (>15) MELD (92.6%), and hepatocellular carcinoma (79.6%). There was consensus to treat low MELD candidates (90.7% “most of the time/always”), but less certainty for intermediate/high MELD candidates (27.8% “sometimes”). Universal post-LT HCV treatment increased (7.4% vs. 57.4%). After DAAs, 42.6% were more willing to use HCV+ donors for HCV+ candidates, and 38.9% were willing to consider using HCV+ donors for HCV- candidates. Overall, with DAAs, centers were more willing to treat HCV+ candidates and recipients and to use HCV+ donors; recent recommendations may help to guide treatment decisions for intermediate/high MELD candidates.

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Potential Liver Transplant Recipients with Hepatitis C: Should They Be Treated Before or After Transplantation?

Cited by 12 publications

References 89 publications

Systematic review with meta‐analysis: effectiveness of direct‐acting antiviral treatment for hepatitis C in patients with hepatocellular carcinoma

Systematic review with meta‐analysis: effectiveness of direct‐acting antiviral treatment for hepatitis C in patients with hepatocellular carcinoma

Clinical considerations in the management of non-alcoholic steatohepatitis cirrhosis pre- and post-transplant: A multi-system challenge

Changes in practice and perception of hepatitis C and liver transplantation: Results of a national survey

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