title: Delisting of liver transplant candidates with chronic hepatitis C after viral eradication: A European study.
abstract: All oral direct acting antivirals (DAA) have been shown to improve the liver function of patients with decompensated cirrhosis but it is presently unknown whether this clinical improvement may lead to the delisting of some patients. The aim of this study was to assess if and which patients can be first inactivated due to clinically improvement and subsequently delisted in a real life setting.
  
  
  
  103 consecutive listed patients without hepatocellular carcinoma were treated with different DAA combinations in 11 European centres between February 2014 and February 2015.
  
  
  
  The cumulative incidence of inactivated and delisted patients by competing risk analysis was 15.5% and 0% at 24weeks, 27.6% and 10.3% at 48weeks, 33.3% and 19.2% at 60weeks. The 34 patients who were inactivated showed a median improvement of 3.4 points for MELD (delta MELD, p<0.0001) and 2 points for Child-Pugh (CP) (delta-CP, p<0.0001). Three variables emerged from the most parsimonious multivariate competing risk model as predictors of inactivation for clinical improvement, namely, baseline MELD classes (MELD 16-20: HR=0.120; p=0.0005, MELD >20:HR=0.042; p<0.0001), delta MELD (HR=1.349; p<0.0001) and delta albumin (HR=0.307; p=0.0069) both assessed after 12weeks of DAA therapy.
  
  
  
  This study showed that all oral DAAs were able to reverse liver dysfunction and favoured the inactivation and delisting of about one patient out-of-three and one patient out-of-five in 60weeks, respectively. Patients with lower MELD scores had higher chances to be delisted. The longer term benefits of therapy need to be ascertained.
  
  
  
  The excellent efficacy and safety profile of the new drugs against Hepatitis C virus, "direct acting antivirals" or DAAs, have made antiviral therapy possible also for patients with advanced liver disease and for those on the waiting list for liver transplantation (LT). This study shows for the first time that the DAAs may lead to a remarkable clinical improvement allowing the delisting of one patient out of 5.
authors.affiliation: Department of Gastroenterology and Hepatology, Liver Unit, Niguarda Hospital, Milan, Italy. Electronic address: luca.belli@ospedaleniguarda.it.
authors.forename: Luca Saverio
authors.initials: LS
authors.lastname: Belli
authors.affiliation: Hepatology & Liver Transplantation Unit, Hospital Universitari I Politècnic La Fe, University of Valencia & Ciberhed, Valencia, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Berenguer
authors.affiliation: Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy.
authors.forename: Paolo Angelo
authors.initials: PA
authors.lastname: Cortesi
authors.affiliation: Digestive Disease Section and International Centre for Digestive Health, School of Medicine and Surgery, University of Milano Bicocca and Yale University Liver Center, Department of Medicine, New Haven, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Strazzabosco
authors.affiliation: Division of Transplantation, Department of Surgery, University of Vienna, Vienna, Austria.
authors.forename: Susanne-Rasoul
authors.initials: SR
authors.lastname: Rockenschaub
authors.affiliation: LiverTransplantation Center, Gastrohepatology Unit, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Martini
authors.affiliation: Liver and Multi-organ Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Morelli
authors.affiliation: Division of Digestive Diseases, 'Maggiore' University Hospital, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Donato
authors.affiliation: Mediterranean Institute for Transplant, Palermo, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Volpes
authors.affiliation: Department of Hepatology, Gastroenterology, and Liver Transplantation, Centre Hospitalier Universitaire (CHU) Saint Eloi, Montpellier, France.
authors.forename: Georges-Philippe
authors.initials: GP
authors.lastname: Pageaux
authors.affiliation: Centre Hepato-Biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, Villejuif, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Coilly
authors.affiliation: Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fagiuoli
authors.affiliation: Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est University, Creteil, France.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Amaddeo
authors.affiliation: Department of Gastroenterology and Hepatology, Liver Unit, Niguarda Hospital, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Perricone
authors.affiliation: Hepatology & Liver Transplantation Unit, Hospital Universitari I Politècnic La Fe, University of Valencia & Ciberhed, Valencia, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Vinaixa
authors.affiliation: Division of Transplantation, Department of Surgery, University of Vienna, Vienna, Austria.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Berlakovich
authors.affiliation: Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Facchetti
authors.affiliation: Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Polak
authors.affiliation: Department of HPB Surgery & Liver Transplantation, University of Birmingham, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.affiliation: Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Est University, Creteil, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Duvoux
mesh_terms: D006528:Carcinoma, Hepatocellular; D019698:Hepatitis C, Chronic; D006801:Humans; D008113:Liver Neoplasms; D016031:Liver Transplantation; D014850:Waiting Lists
keywords: Cirrhosis; Delisting; Direct acting antivirals; HCV; Liver transplantation