Background: Treatment with direct-acting antiviral agents (DAAs) in HCV patients is associated with high sustained virologic response (SVR) rates. It is hoped that cirrhosis regresses in a proportion of HCV patients who achieve SVR. However, clinical and histological data regarding post-SVR in cirrhotic patients is lacking. We aimed to evaluate histological characteristics of liver explants in HCV patients who developed SVR post-DAA treatment (SVR+).

Design: Fifty-eight adult HCV patients who underwent LT at our institution (2014-2016) were reviewed. The study group comprised of 25 SVR+ patients, while 33 HCV patients who had not been treated with DAAs comprised the control group. Two pathologists, blinded to clinical information, simultaneously evaluated 4 representative sections from each liver explant. The Laennec subtype of cirrhosis was determined: 4A (mild cirrhosis, nodules enclosed by thin fibrous septa), 4B (moderate cirrhosis, nodules enclosed by broad fibrous septa), and stage 4C (severe cirrhosis, very broad fibrous septa with micronodules). In addition, the histology activity index (HAI) of each case was documented.

Results: Patients in the study group (M:F=1.3:1, mean age=63.8 years) and control group (M:F=2.3:1, mean age=61.7 years) showed similar characteristics. SVR was noted from 4 to 90 weeks prior to LT. Cirrhosis was identified for both groups. Prevalence of SVR+ patients with stage 4A, 4B, and 4C cirrhosis was 20%, 64%, and 16%, respectively. A similar proportion of cirrhosis subtype was noted in the control group: 27%, 64%, and 9%, respectively (p=0.223). There was no significant difference in the HAI of both groups (p=0.62), as most patients in both groups showed minimal (HAI=1-4) to mild inflammation (HAI=5-8).

Conclusion: Moderate cirrhosis (stage 4B) is the most frequent subtype seen in our patient cohort. Necroinflammatory activity and fibrosis of HCV patients who received DAAs also do not correlate with their SVR status. Since there is no difference in the degree of necroinflammation in both SVR+ and control patients, this study supports the observation that chronic inflammation may be immunologically driven and it persists despite the absence of the virus. The study also shows that the role of SVR in fibrosis regression may not have a noticeable effect, at least over a short period of time.

CITATION INFORMATION: Putra J, Schiano T, Fiel M. Does Cirrhosis Regress in HCV Liver Transplant Recipients Achieving Sustained Virologic Response in the Era of Direct-Acting Antiviral Agents? Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress