Open AccessEfficacy and safety of daclatasvir‐based antiviral therapy in hepatitis C virus recurrence after liver transplantation. Role of cirrhosis and genotype 3. A multicenter cohort study
Author(s) -
Salcedo Magdalena,
Prieto Martín,
Castells Lluís,
Pascasio Juan Manuel,
Montero Alvarez Jose Luis,
Fernández Inmaculada,
SánchezAntolín Gloria,
GonzálezDiéguez Luisa,
GarcíaGonzalez Miguel,
Otero Alejandra,
Lorente Sara,
Espinosa Maria Dolores,
Testillano Milagros,
González Antonio,
Castellote Jose,
Casafont Fernando,
Londoño MariaCarlota,
Pons Jose Antonio,
Molina Pérez Esther,
CuervasMons Valentín,
Pascual Sonia,
Herrero Jose Ignacio,
Narváez Isidoro,
Vinaixa Carmen,
Llaneras Jordi,
Sousa Jose Manuel,
Bañares Rafael
Publication year - 2017
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12999
Subject(s) - medicine , daclatasvir , ribavirin , gastroenterology , cirrhosis , liver transplantation , cohort , hepatitis c virus , hepatitis c , clinical endpoint , transplantation , surgery , immunology , randomized controlled trial , virus
Summary Direct‐acting antiviral agents ( DAA ) combining daclatasvir ( DCV ) have reported good outcomes in the recurrence of hepatitis C virus ( HCV ) infection after liver transplant ( LT ). However, its effect on the severe recurrence and the risk of death remains controversial. We evaluated the efficacy, predictors of survival, and safety of DAC ‐based regimens in a large real‐world cohort. A total of 331 patients received DCV ‐based therapy. Duration of therapy and ribavirin use were at the investigator's discretion. The primary end point was sustained virological response ( SVR ) at week 12. A multivariate analysis of predictive factors of mortality was performed. Intention‐to‐treat ( ITT ) and per‐protocol SVR were 93.05% and 96.9%. ITT ‐ SVR was lower in cirrhosis ( n = 163) (96.4% vs. 89.6% P = 0.017); the SVR in genotype 3 ( n = 91) was similar, even in advanced fibrosis (96.7% vs. 88%, P = 0.2). Ten patients (3%) experienced virological failure. Therapy was stopped in 18 patients (5.44%), and ten died during treatment. A total of 22 patients (6.6%) died. Albumin ( HR = 0.376; 95% CI 0.155–0.910) and baseline MELD ( HR = 1.137; 95% CI : 1.061–1.218) were predictors of death. DCV ‐based DAA treatment is efficacious and safe in patients with HCV infection after LT . Baseline MELD score and serum albumin are predictors of survival irrespective of viral response.