Source: Abstract #THU-457 Favourable virological and clinical outcomes at 1 year after liver transplantation in hepatitis C virus-positive patients who received direct-acting antivirals on the waiting list-S. Martini, et al.
Study Aims and Results: The return of hepatitis C is very common for people who are viremic when receiving a liver transplant. Significant liver stiffness was highly linked with the transplantation failure one year post treatment. This study looked at what effects treatment of hepatitis C with direct acting antivirals (DAAs) pre-transplant had on health outcomes 1 year after transplantation. From July 2014 and October 2016 there were 64 hepatitis C positive people treated with direct acting antivirals + ribavirin while on the wait list who underwent a transplantation. Of those, 16 participants made the transition from pre-to post-transplant and remained hepatitis C negative. The median age of recipients was 57 years old; 84% were male. The median donor was 66 years old. The amount of time participants who were hepatitis C negative prior to liver transplant was 94 days. Of the 55 participants who reached SVR12 post-transplant, 54 of them were hepatitis C negative. The median number of days for follow up post-transplant was 377.
Conclusion: This study was able to show that using DAAs pre-, and close to, transplantation resulted in 98% of the participants being hepatitis C negative. Treating before transplant also led to fewer post-transplantation liver complications and rejections. Even though many of the transplantation donors were elderly, 75% of the participants showed absent/mild liver scarring 1 year after transplantation.
Editorial Comments: Liver transplantation is expensive, scary and comes with a risk of failure. This study showed that curing someone of hepatitis C before they receive a transplant can significantly reduce the poor outcomes that have been shown among those who don’t receive similar treatment. Being able to reduce liver scarring and the risk of transplant being rejected is encouraging. This gives hope to those seeking a transplant and confidence for all involved that it will work and they can remain cured.
Source: Abstract #THU-439 interferon-free therapy is effective and safe for hepatitis C recurrence in liver transplant hepatitis C virus/human immunodeficiency virus coinfected recipients: a case-control study- M.-C. Londoño, et al.
Study Aims and Results: Current studies show interferon-free treatments are successful and safe for monoinfected liver transplant recipients with hepatitis C. There are fewer examples looking at how successful direct acting antivirals are in HCV/HIV co-infected liver transplant recipients. This study focused on looking at the success and side effects of interferon-free treatment in a national cohort of HCV/HIV coinfected participants who had HCV return after transplantation. There were 38 HCV/HIV-coinfected and 133 HCV monoinfected liver transplant participants enrolled in the study. The two groups were fairly similar in gender, age, genotype, viral load, fibrosis stage and the amount of time from transplantation to treatment at 38 and 47 months. All coinfected participants were on HIV treatment; 84% had a RNA viral load of less than 50 copies/ml (undetectable) and a median white blood cell count of 367 cells/uL. For comparison, 1100-1400 white blood cells/ul is the range of someone who is not immunocompromised. The top three direct acting antiviral treatments that were used are as follows: ledipasvir + sofosbuvir ± ribavirin (RBV) (33%), simeprevir+ sofosbuvir ± RBV (31%), daclatasvir + sofosbuvir ± RBV (28%), simeprevir+daclatasvir ± RBV (5%), and AbbVie’s 3D (3%). More than half of each cohort received RBV. The treatment success was also close among the cohorts, with 92% of the coinfected group having a sustained virologic response 12 weeks post treatment (cure), and 96% of the monoinfected group. There were no serious side effects of treatment or differences in success related to genotype and advanced fibrosis.
Conclusion: This study was able to show interferon-free treatments for HIV-positive people who have had hepatitis C return are successful with few side effects. As important, this study showed that the success rates of interferon-free treatment were similar to hepatitis C monoinfected participants.
Editorial Comments: Tackling the issue of treatment for people who receive a liver transplant and have hepatitis C return is crucial to any elimination plan. This is important not only among monoinfected people but those who are coinfected with compromised immune systems. The closer we can get to a treatment that is effective on both cohorts and has fewer side effects, the more likely we are to eliminate hepatitis C and save lives. Most importantly, this study shows that even after liver transplants people can be treated.
Abstract #THU-451 History of marijuana use does not affect outcomes on the liver transplant waitlist—P. Kotwani, et al. by Lucinda K. Porter, RN
Study Aims and Results: The goal of this study was to also determine the prevalence and factors associated with marijuana use by people on the liver transplant waitlist. Additionally, researchers sought to evaluate the risk of waitlist death, delisting, and receiving of transplants among current and prior marijuana users. This two-year retrospective study of 884 adults found marijuana use was 48%; 7% were current users and 41% prior users. The incidence of death/delisting or receiving transplant was the same among marijuana users and non-users.
Conclusions: History of marijuana use was not associated with worse outcomes on the liver transplant waitlist. Based on these data, the researchers concluded that marijuana use alone may not warrant contraindication or disqualification from transplant listing.
Editorial Comments: More than half the states in the U.S. have legalized the use of medical marijuana, but that doesn’t mean you can use it if you are on the transplant list. Alcohol is legal in all states but drinking it disqualifies you from receiving a liver transplant, since alcohol damages the liver. Research on marijuana’s effect on the liver is long overdue.