Antivirals Change Liver Transplant Picture

With several new antivirals for hepatitis C infection available and more in the pipeline, the need for liver transplantation could drop, making more donor organs available for those who do need them, a Philadelphia team reports.

The US Food and Drug Administration approval of potent antiviral therapies has increased the cure rate for hepatitis C infection to nearly 100%.

In an abstract presented orally on May 5 at the 2015 American Transplant Congress in Philadelphia, PA, Santiago Munoz, MD and David Reich, MD of Hahnemann University Hospital in Philadelphia predict the drugs will “have a substantial impact on the liver transplant wait-list and organ allocation.”

The team cited the effects of new hep-C drugs like the antiviral combination sofosbuvir-ledipasvir (Harvoni/Gilead), as well as that drug used in combination with ribavirin. The researchers’ aim was to see if the treatments would result in changes in the MELD scores of patients on liver-transplant waiting lists. The scores rate severity of liver disease.

Using the 4,612 hep-C patients on a national liver transplant waiting list in 2012, the researchers calculated how many of them would improve enough so they would not need a transplant. They made an assumption based on an earlier published study that found that in patients with decompensated cirrhosis there was an 89-91% cure rate and a mean 2.5 point reduction in the MELD score of patients after 12 weeks of treatment with Harvoni plus ribavirin. They studied three predictive models, dependent on the long term extent of improvement.

According to one model, they estimated that after an average of 13.2 months on the antiviral therapy, about 61% of the waiting list patients (2,820) would no longer need the transplant.

Simultaneously, the team concluded, 857 donated livers would become available to those patients who still needed transplants.

The impact of new hep-C drugs on future demand for transplants warrants continued observation. The redistribution of donor organs could result in “a substantial decrease in the gap between listed patients and available livers,” the authors wrote.