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Title: Efficacy 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.
Authors: Salcedo, Magdalena
Prieto, Martín
Castells, Lluís
Pascasio, Juan Manuel
Montero Alvarez, Jose Luis
Fernández, Inmaculada
Sánchez-Antolín, Gloria
González-Diéguez, Luisa
García-Gonzalez, Miguel
Otero, Alejandra
Lorente, Sara
Espinosa, Maria Dolores
Testillano, Milagros
González, Antonio
Castellote, Jose
Casafont, Fernando
Londoño, Maria-Carlota
Pons, Jose Antonio
Molina Pérez, Esther
Cuervas-Mons, Valentín
Pascual, Sonia
Herrero, Jose Ignacio
Narváez, Isidoro
Vinaixa, Carmen
Llaneras, Jordi
Sousa, Jose Manuel
Bañares, Rafael
Keywords: Model for End-Stage Liver Disease;daclatasvir;efficacy and safety;recurrence of HCV;survival prognostic model
metadata.dc.subject.mesh: Adult
Aged, 80 and over
Antiviral Agents
Hepatitis C
Immunosuppression Therapy
Liver Transplantation
Middle Aged
Postoperative Complications
Retrospective Studies
Sustained Virologic Response
Issue Date: 27-Jul-2017
Abstract: 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.
metadata.dc.identifier.doi: 10.1111/tri.12999
Appears in Collections:Producción 2020

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