There have been significant improvements in the outcomes of patients chronically infected with hepatitis C virus (HCV), including those with decompensated cirrhosis (DC), since the widespread use of direct-acting antivirals (DAAs). The authors were interested in changes in the indications and results of liver transplantation (LT) in the past 10 years in Europe, particular the impact that DAAs have had. They performed a cohort study on data from adult LTs performed between 2007 and 2017 for HCV, hepatitis B virus (HBV), alcohol (EtOH) and non-alcoholic steatohepatitis (NASH). The period was divided into different eras: interferon (IFN/RBV, 2007-2010), protease inhibitors (PI, 2011-2013) and second generation DAAs (DAA, 2014-June 2017). They found that of a total number of 60,527 LTs, 36,382 were performed in patients with HCV, HBV, EtOH and NASH. The percentage of LTs performed due to HCV-related liver disease changed significantly over time, decreasing from 22.8% in the IFN/RBV era to 17.4% in the DAA era; while those performed for NASH increased significantly. During the DAA era, the percentage of LTs for HCV decreased significantly from 21.1% (2014) to 10.6% (2017). This decline was seen even more in patients with DC (HCV-DC, -58.0%) than in those with hepatocellular carcinoma (HCC) associated with HCV (HCV-HCC, -41.2%). The 3-year survival of LT recipients with HCV-related liver disease has improved from 65.1% in the IFN/RBV era to 76.9% in the DAA era, and is now similar to the survival of recipients with HBV infection. Therefore the number of LTs due to HCV infection in Europe is rapidly declining for both HCV-DC and HCV-HCC, and post-LT survival has dramatically improved over the last 3 years.
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