Histological Assessment of the Liver Explant in Transplanted HCV-Patients Achieving Sustained Virologic Response with Direct-Acting Antiviral Agents

Abstract

Aims

The use of direct-acting anti-viral agents (DAAs) has resulted in extremely high sustained virologic response (SVR) rates in patients being treated while on liver transplantation (LT) waiting lists. The aim of this study was to evaluate the histological findings of HCV patients who achieved SVR after receiving DAA treatment (SVR(+)) prior to LT and comparing them to HCV patients who had not achieved SVR (SVR(-)).

Methods and Results

Fifty-eight adult HCV patients who underwent LT at our institution from 2014-2016 were included in the study. Two pathologists, blinded to SVR status, simultaneously evaluated the histological sections. Assessment included the Histology Activity Index (HAI/modified Knodell score), fibrosis stage (Ishak score), and Laennec cirrhosis stage. The study group comprised of 25 SVR(+) patients (56% male, mean age=63.8), while the control group was composed of 33 SVR(-) patients (69% male, mean age=61.7). There was no significant difference in HAI between groups (p=0.414). Patients who achieved SVR also did not show less portal inflammation (p=0.787), interface hepatitis (p=0.999), confluent necrosis (p=0.627), or spotty necrosis (p=0.093) compared to the control group. There was a trend towards higher degree of inflammation in patients who achieved SVR shorter than 24 weeks (p=0.07). The degree of focal lytic necrosis/apoptosis and portal inflammation was more prominent in SVR(+) patients with shorter interval time.

Conclusions

Our study is the first to report the persistent inflammation in HCV patients who received DAAs prior to LT. This supports the notion that inflammation is immunologically driven and inflammation persists despite the absence of virus.

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