Long-term functional outcomes of sofosbuvir-based antiviral treatment were evaluated in a cohort study involving 16 Italian centres within the international compassionate use programme for post-transplant hepatitis C virus (HCV) recurrence. Seventy-three patients with cirrhosis (n=52) or fibrosing cholestatic hepatitis (FCH, n=21) received 24-week sofosbuvir with ribavirin±pegylated interferon or interferon-free sofosbuvir-based regimen with daclatasvir/simeprevir+ribavirin. The patients were observed for a median time of 103 (82-112) weeks. Twelve of 73 (16.4%) died (10 non-FCH, 2 FCH) and two underwent re-LT. Sustained virological response was achieved in 46 of 66 (69.7%): 31 of 47 (66%) non-FCH and 15 of 19 (79%) FCH patients. All relapsers were successfully retreated. Comparing the data of baseline with last follow-up, MELD and Child-Turcotte-Pugh scores improved both in non-FCH (15.3±6.5 vs 10.5±3.8, P<.0001 and 8.4±2.1 vs 5.7±1.3, P<.0001, respectively) and FCH (17.3±5.9 vs 10.1±2.8, P=.001 and 8.2±1.6 vs 5.5±1, P=.001, respectively). Short-treatment mortality was higher in patients with baseline MELD≥25 than in those with MELD<25 (42.9% vs 4.8%, P=.011). Long-term mortality was 53.3% among patients with baseline MELD≥20 and 7.5% among those with MELD<20 (P<.0001). Among deceased patients 75% were Child-Turcotte-Pugh class C at baseline, while among survivors 83.9% were class A or B (P<.0001). Direct acting antivirals-based treatments for severe post-transplant hepatitis C recurrence, comprising fibrosing cholestatic hepatitis, significantly improve liver function, even without viral clearance and permit an excellent long-term survival. The setting of severe HCV recurrence may require the identification of “too-sick-to-treat patients” to avoid futile treatments.
Long-term outcomes of direct acting antivirals in post-transplant advanced hepatitis C virus recurrence and fibrosing cholestatic hepatitis / R. Vukotic, F. Conti, S. Fagiuoli, M.C. Morelli, L. Pasulo, M. Colpani, F.G. Foschi, S. Berardi, P. Pianta, M. Mangano, M.F. Donato, F. Malinverno, S. Monico, M. Tame, G. Mazzella, L.S. Belli, R. Vigano, P. Carrai, P. Burra, F.P. Russo, I. Lenci, P. Toniutto, M. Merli, L. Loiacono, R. Iemmolo, A.M. Degli Antoni, A. Romano, A. Picciotto, M. Rendina, P. Andreone. - In: JOURNAL OF VIRAL HEPATITIS. - ISSN 1352-0504. - 24:10(2017 Oct), pp. 858-864.
|Titolo:||Long-term outcomes of direct acting antivirals in post-transplant advanced hepatitis C virus recurrence and fibrosing cholestatic hepatitis|
|Parole Chiave:||antiviral therapy; fibrosing cholestatic hepatitis; liver transplant; long-term outcome; severe hepatitis C virus recurrence|
|Settore Scientifico Disciplinare:||Settore MED/12 - Gastroenterologia|
|Data di pubblicazione:||ott-2017|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1111/jvh.12712|
|Appare nelle tipologie:||01 - Articolo su periodico|