Public Release: 

Treating patients for hepatitis C could reduce the need for liver transplants

Patients with severe liver damage and hepatitis C virus comprise 30 percent of adults on the liver transplant waiting list

European Association for the Study of the Liver

April 14, 2016, Barcelona, Spain: A new study presented today demonstrates that patients on the liver transplant list with Hepatitis C virus (HCV) and severe liver damage were more likely to be taken off the list or have their need of a liver transplant reduced as a result of direct-acting antiviral therapy.

The study, presented at The International Liver Congress™ 2016 in Barcelona, Spain, showed that the condition of 35% of these patients improved to such an extent that they were no longer considered in urgent need of a transplant, while 20% of the patients no longer required a liver transplant at all.

Severe liver damage, also known as decompensated cirrhosis, is a life threatening condition in which extensive scarring of the liver results in its inability to function properly.1 The only treatment currently available for decompensated cirrhosis is a liver transplant.1 Patients with decompensated HCV cirrhosis comprise 30% of adults on the liver transplant waiting list. There are over 8,500 people in Europe2 and over 15,000 people in the United States waiting for a liver transplant, with this number expected to increase.3 Furthermore, in the United States approximately 16% of patients will die while awaiting a liver transplant.3

"The results of the study are very encouraging, but a word of caution is to be mentioned since it is presently unknown how long the clinical improvement will last," said Dr Luca Belli, Gastroenterology and Hepatology Liver Unit, Niguarda Hospital, Milan, Italy and lead author of the study. "In this respect we encourage multi-national observational studies on patients who have been listed for decompensated HCV cirrhosis and subsequently de-listed because of clinical improvement. It is in fact critical to assess the long-term risks of death, further re-deterioration and development of liver cancer more specifically, as all these factors still need to be verified."

The retrospective European study was conducted over one year on 103 liver transplant candidates with decompensated HCV cirrhosis and without hepatocellular carcinoma, the most common type of liver cancer. These patients had been treated with direct-acting antiviral combinations, medicines which have been used to treat and cure almost all patients with HCV.

Patients in the study that no longer urgently required a transplant (n=25) demonstrated, on average, an 11% (or four point) decrease in severity of disease based on the Model for End-Stage Liver Disease (MELD) score, a commonly used scale which assesses disease severity and urgency for a liver transplant. These patients also saw a 20% (or three point) improvement on the Child-Pugh score, another commonly used scale to assess the prognosis of chronic liver diseases, including cirrhosis.

"These results show notable improvements in the outlook for some of these patients with HCV and decompensated cirrhosis," said Professor Laurent Castera, EASL Secretary General. "Treating these patients with direct-acting antiviral therapy could result in those with a more pressing need for a liver transplant receiving the donation they need, potentially reducing the number of deaths that occur in patients on the waiting list."

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Scoring systems

The MELD score is a reliable, numerical measure of mortality risk in patients with end-stage liver disease and helps to prioritise allocation of livers for transplant. The score ranges from 6, for those with less severe disease, to 40, for those who are critically ill. The score determines how urgently someone requires a transplant within three months and takes into consideration results from three routine lab tests, which include bilirubin (a measure of the ability of the liver to excrete bile), the International Normalised Ratio (INR) of Prothrombin Time (a measure of the liver's ability to make blood clotting factors), and creatinine (a measure of kidney function).4

The Child-Pugh score is a scoring system to measure the severity of chronic liver disease. The score takes into account bilirubin, INR, serum albumin (a measure of a protein made by the liver), ascites (the accumulation of fluid in the abdomen), and the presence of hepatic encephalopathy (a condition observed in patients with cirrhosis characterised by personality changes, intellectual impairment and depressed levels of consciousness). The Child-Pugh score can range from 5, for those with less severe disease, to 15, for those who are critically ill.5

About The International Liver Congress™

This annual congress is the biggest event in the EASL calendar, attracting scientific and medical experts from around the world to learn about the latest in liver research. Attending specialists present, share, debate and conclude on the latest science and research in hepatology, working to enhance the treatment and management of liver disease in clinical practice. This year, the congress is expected to attract approximately 10,000 delegates from all corners of the globe. The International Liver Congress™ takes place from April 13 - 17, 2016, at the Fira Barcelona Gran Via, Barcelona, Spain.

About EASL

Since EASL's foundation in 1966, this not-for-profit organisation has grown to over 4,000 members from all over the world, including many of the leading hepatologists in Europe and beyond. EASL is the leading liver association in Europe, having evolved into a major European Association with international influence, with an impressive track record in promoting research in liver disease, supporting wider education and promoting changes in European liver policy.

Contact

For more information, please contact the ILC Press Office at:

Onsite location reference

Liver Transplantation, Hall 8.0-B3
Thursday 14 April, 16:00 - 18:00
Presenter: Luca Belli, Italy
Abstract: PS036, Impact of direct anti-viral agents on inactivation/de-listing of liver transplant candidates listed for decompensated C cirrhosis: A European study

Author disclosures of interest

Grant/Research support from Gilead, AbbVie and BMS. Consulting/Advisory board: Gilead.

References

1 Franciscus, A & HCV Advocate. HCSP Fact Sheet - HCV Disease Progression. Available from: http://hcvadvocate.org/hepatitis/factsheets_pdf/cirrhosis.pdf. Last accessed: March 2016.
2 European Commission. Organ donation and transplantation: Facts and figures. Published November 2014. Available from: http://ec.europa.eu/health/blood_tissues_organs/docs/ev_20141126_factsfigures_en.pdf. Last accessed: March 2016.
3 Organ Procurement and Transplantation Network. Annual Data Report 2011: Liver. Available from: http://srtr.transplant.hrsa.gov/annual_reports/2011/pdf/03_%20liver_12.pdf. Last accessed: March 2016.
4 United Network for Organ Sharing. Talking about transplantation: Questions & answers for transplant candidates about MELD and PELD. Available from: https://www.unos.org/wp-content/uploads/unos/MELD_PELD.pdf. Last accessed: March 2016.
5 Weerakkody Y, et al. Child-Pugh score. Available from: http://radiopaedia.org/articles/child-pugh-score. Last accessed: March 2016.

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