Need for liver transplants due to hepatitis C drops in United Kingdom

Keith Alcorn
Published:
22 October 2018

Registrations for liver transplants due to complications of hepatitis C infection in the United Kingdom fell sharply between 2013 and 2016, coinciding with the gradual increase in availability of direct-acting antiviral treatment, researchers from seven of the country’s leading liver clinics report this week in the Journal of Viral Hepatitis.

The decline in need matches a pattern also reported in Italy and the United States in recent years.

The UK study looked at registrations for liver transplant in the National Health Transplant Database from 2006 to 2017 and divided registrations between the period prior to the introduction of direct-acting antiviral treatment (2016 to 2014) and the period of direct-acting antiviral introduction (April 2014 to April 2016).

The researchers compared deaths, transplants, removal from the transplant list due to improvement or deterioration and the number still waiting, between 2013 and 2016.

A total of 706 people with hepatitis C virus (HCV)-associated cirrhosis were registered for transplant prior to 2014 and 126 were registered between 2014 and 2016. HCV-related cirrhosis as a reason for transplant fell from 10.5% of all registrations in 2013 to 4.7% of all registrations in 2016 (p < 0.0001). During the same period registrations due to alcoholic liver disease or to cancer remained stable. Registrations due to metabolic causes increased from 1.9% in 2006 to 11.5% of all registrations in 2016; the study authors comment that this change probably reflects the growing prevalence of non-alcoholic fatty liver disease (NAFLD).

Registrations due to hepatocellular carcinoma (HCC, liver cancer) associated with hepatitis C declined sharply after 2013. Four hundred and eighty-seven people were registered for transplant prior to 2014 as a result of HCV-associated HCC, and 111 between 2014 and 2016. Whereas 46.4% of all transplant registrations due to liver cancer were associated with hepatitis C in 2013, 33.7% were associated with HCV in 2016 (P = 0.002). The proportion of people on the transplant list who died from HCV-associated HCC fell from 2.9% in 2013 to 0% in 2016 (p = 0.04).

The researchers note that the decline in transplant registration due to HCV-associated HCC supports previous evidence that direct-acting antiviral treatment does not lead to an increase in the incidence of HCC.

Direct-acting antivirals were introduced through an early access programme in 2014 in the United Kingdom, but access was confined to people with advanced liver disease and the proportion of people with cirrhosis who received treatment between 2014 and 2016 was modest. Nevertheless, their study of transplant registrations shows the efficacy of direct-acting antiviral therapy, say the authors.

Reference

Vaziri A et al. Liver transplant listing for hepatitis C associated cirrhosis and hepatocellular carcinoma has fallen in the United Kingdom since the introduction of direct acting antiviral therapy. J Vir Hepatitis, advance online publication, 19 October 2018.