BACKGROUND & AIMS The efficacy of direct-acting antivirals (DAAs) has dramatically changed the prognosis of patients with chronic hepatitis C. We aimed to evaluate the impact of DAA therapy on the composition of the liver transplant (LT) waiting list and the early post-transplant survival. METHODS We evaluated all patients admitted to the waiting list for a primary LT between 1st January 2008 and 31st of December 2016 in Catalonia, Spain. Time span was divided into two periods according to the availability of different antiviral therapies: 2008-2013 (interferon-based therapies) and 2014-2016 (DAA). Changes in the indications of LT and the aetiology of liver disease, as well as post-LT patient survival, were evaluated according to the year of inclusion and transplantation, respectively. RESULTS We included 1,483 patients. Admissions in the waiting list for hepatitis C virus (HCV)-related liver disease decreased significantly, from 47% in 2008-2013 to 35% in 2014-2016 (p <0.001), particularly because of a reduction in patients with decompensated cirrhosis. In contrast, NASH-related inclusions increased from 4% to 7% (p = 0.003). Three-year post-LT patient survival increased significantly in the second period in the whole cohort (82% vs. 91%, p = 0.002), because of better survival in anti-HCV positive patients (76% vs. 91%, p = 0.001), but not in anti-HCV negative patients (88% vs. 91% p = 0.359). Anti-HCV positive serology, the time period of 2008-2013 and higher donor age were independently associated with post-LT mortality in the whole cohort; while time period and donor age were independently associated with post-LT mortality in anti-HCV positive recipients. CONCLUSIONS The high efficacy of DAAs is associated with significant changes in the composition of the LT waiting list and, more importantly, results in improved post-transplant survival. LAY SUMMARY The efficacy of the new direct-acting antivirals is associated with a significant improvement in survival of patients undergoing liver transplantation because of hepatitis C virus-related liver disease. In addition, it has decreased the number of patients with hepatitis C that need a liver transplant.

中文翻译：

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直接抗 HCV 药物的疗效提高了早期肝移植后的存活率，并导致候补名单组成的显着变化

背景与目的 直接作用抗病毒药物 (DAA) 的疗效显着改变了慢性丙型肝炎患者的预后。我们旨在评估 DAA 治疗对肝移植 (LT) 等待名单和早期后-移植存活。方法 我们评估了 2008 年 1 月 1 日至 2016 年 12 月 31 日期间在西班牙加泰罗尼亚进入初级 LT 等候名单的所有患者。根据不同抗病毒疗法的可用性，时间跨度分为两个时期：2008-2013（基于干扰素的疗法）和 2014-2016（DAA）。分别根据纳入年份和移植年份评估 LT 适应症和肝病病因学的变化，以及 LT 后患者的存活率。结果 我们纳入了 1,483 名患者。丙型肝炎病毒 (HCV) 相关肝病等候名单中的入院人数显着减少，从 2008-2013 年的 47% 下降到 2014-2016 年的 35%（p <0.001），特别是因为失代偿期肝硬化患者减少。相比之下，与 NASH 相关的内含物从 4% 增加到 7% (p = 0.003)。由于抗 HCV 阳性患者的存活率更高（76% 对 91%，p），整个队列的第二阶段 LT 后三年患者存活率显着增加（82% 对 91%，p = 0.002） = 0.001)，但在抗 HCV 阴性患者中则不然（88% 对 91%，p = 0.359）。抗-HCV 阳性血清学、2008-2013 年的时间段和较高的供体年龄与整个队列的 LT 后死亡率独立相关；而时间段和供体年龄与抗 HCV 阳性受者的 LT 后死亡率独立相关。结论 DAA 的高疗效与 LT 等候名单组成的显着变化有关，更重要的是，可提高移植后的存活率。概述 新型直接作用抗病毒药物的疗效与因丙型肝炎病毒相关的肝病而接受肝移植的患者的生存率显着提高有关。此外，它还减少了需要肝移植的丙型肝炎患者的数量。概述 新型直接作用抗病毒药物的疗效与因丙型肝炎病毒相关的肝病而接受肝移植的患者的生存率显着提高有关。此外，它还减少了需要肝移植的丙型肝炎患者的数量。概述 新型直接作用抗病毒药物的疗效与因丙型肝炎病毒相关的肝病而接受肝移植的患者的生存率显着提高有关。此外，它还减少了需要肝移植的丙型肝炎患者的数量。