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
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.