{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:59:54Z","timestamp":1790402394405,"version":"4.1.0"},"reference-count":31,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T00:00:00Z","timestamp":1691366400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>(1) Background: Little is known about the long-term impact of sustained virological response (SVR) on fibrosis progression and patient survival in liver transplantation (LT) recipients treated with direct-acting antivirals (DAAs). We investigated liver fibrosis evolution and patient survival in hepatitis C virus (HCV)-infected patients receiving DAAs after LT. (2) Methods: All consecutive HCV-infected patients treated with DAAs after LT between May 2014 and January 2019 were considered. The clinical and virological features were registered at the baseline and during the follow-up. The liver fibrosis was assessed by liver biopsy and\/or transient elastography (TE) at the baseline and at least 1 year after the end of treatment (EoT). (3) Results: A total of 136 patients were included. The SVR12 was 78% after the first treatment and 96% after retreatment. After the SVR12, biochemical tests improved at the EoT and remained stable throughout the 3-year follow-up. Liver fibrosis improved after the SVR12 (p &lt; 0.001); nearly half of the patients with advanced liver fibrosis experienced an improvement of an F \u2264 2. The factors associated with lower survival in SVR12 patients were the baseline platelet count (p = 0.04) and creatinine level (p = 0.04). (4) Conclusions: The long-term follow-up data demonstrated that SVR12 was associated with an improvement in hepatic function, liver fibrosis, and post-LT survival, regardless of the baseline liver fibrosis. The presence of portal hypertension before the DAAs has an impact on patient survival, even after SVR12.<\/jats:p>","DOI":"10.3390\/v15081702","type":"journal-article","created":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T12:35:42Z","timestamp":1691498142000},"page":"1702","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Long-Term Impact of Direct-Acting Antivirals on Liver Fibrosis and Survival in HCV-Infected Liver Transplant Recipients"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0101-1938","authenticated-orcid":false,"given":"Martina","family":"Gambato","sequence":"first","affiliation":[{"name":"Multivisceral Transplant and Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, Azienda Ospedale-Universit\u00e0 Padova, Via Giustiniani 2, 35100 Padova, Italy"},{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padova, 35100 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Manuli","sequence":"additional","affiliation":[{"name":"Multivisceral Transplant and Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, Azienda Ospedale-Universit\u00e0 Padova, Via Giustiniani 2, 35100 Padova, Italy"},{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padova, 35100 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2638-2559","authenticated-orcid":false,"given":"Erica N.","family":"Lynch","sequence":"additional","affiliation":[{"name":"Multivisceral Transplant and Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, Azienda Ospedale-Universit\u00e0 Padova, Via Giustiniani 2, 35100 Padova, Italy"},{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padova, 35100 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Battistella","sequence":"additional","affiliation":[{"name":"Multivisceral Transplant and Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, Azienda Ospedale-Universit\u00e0 Padova, Via Giustiniani 2, 35100 Padova, Italy"},{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padova, 35100 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Germani","sequence":"additional","affiliation":[{"name":"Multivisceral Transplant and Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, Azienda Ospedale-Universit\u00e0 Padova, Via Giustiniani 2, 35100 Padova, Italy"},{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padova, 35100 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Senzolo","sequence":"additional","affiliation":[{"name":"Multivisceral Transplant and Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, Azienda Ospedale-Universit\u00e0 Padova, Via Giustiniani 2, 35100 Padova, Italy"},{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padova, 35100 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6734-7178","authenticated-orcid":false,"given":"Alberto","family":"Zanetto","sequence":"additional","affiliation":[{"name":"Multivisceral Transplant and Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, Azienda Ospedale-Universit\u00e0 Padova, Via Giustiniani 2, 35100 Padova, Italy"},{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padova, 35100 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Ferrarese","sequence":"additional","affiliation":[{"name":"Multivisceral Transplant and Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, Azienda Ospedale-Universit\u00e0 Padova, Via Giustiniani 2, 35100 Padova, Italy"},{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padova, 35100 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4548-8308","authenticated-orcid":false,"given":"Alessandro","family":"Vitale","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padova, 35100 Padova, Italy"},{"name":"Hepatobiliary Urgery and Liver Transplantation, Department of Surgery, Oncology and Gastroenterology, Azienda Ospedale-Universit\u00e0 Padova, 35100 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3459-7306","authenticated-orcid":false,"given":"Enrico","family":"Gringeri","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padova, 35100 Padova, Italy"},{"name":"Hepatobiliary Urgery and Liver Transplantation, Department of Surgery, Oncology and Gastroenterology, Azienda Ospedale-Universit\u00e0 Padova, 35100 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"Cillo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padova, 35100 Padova, Italy"},{"name":"Hepatobiliary Urgery and Liver Transplantation, Department of Surgery, Oncology and Gastroenterology, Azienda Ospedale-Universit\u00e0 Padova, 35100 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8791-191X","authenticated-orcid":false,"given":"Patrizia","family":"Burra","sequence":"additional","affiliation":[{"name":"Multivisceral Transplant and Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, Azienda Ospedale-Universit\u00e0 Padova, Via Giustiniani 2, 35100 Padova, Italy"},{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padova, 35100 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4127-8941","authenticated-orcid":false,"given":"Francesco Paolo","family":"Russo","sequence":"additional","affiliation":[{"name":"Multivisceral Transplant and Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, Azienda Ospedale-Universit\u00e0 Padova, Via Giustiniani 2, 35100 Padova, Italy"},{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padova, 35100 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S120","DOI":"10.1016\/j.jhep.2014.07.020","article-title":"Treatment options in patients with decompensated cirrhosis, pre- and post-transplantation","volume":"61","author":"Gambato","year":"2014","journal-title":"J. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/j.jhep.2018.06.010","article-title":"Impact of DAAs on liver transplantation: Major effects on the evolution of indications and results. An ELITA study based on the ELTR registry","volume":"69","author":"Belli","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1016\/j.jhep.2017.08.008","article-title":"Clinical outcomes of patients undergoing antiviral therapy while awaiting liver transplantation","volume":"67","author":"Pascasio","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(18)32111-1","article-title":"Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment: A prospective cohort study","volume":"393","author":"Carrat","year":"2019","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/j.jhep.2016.06.019","article-title":"Outcomes after successful direct-acting antiviral therapy for patients with chronic hepatitis C and decompensated cirrhosis","volume":"65","author":"Cheung","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.jhep.2016.08.004","article-title":"Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population","volume":"66","author":"Innes","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Nahon, P., Bourcier, V., Layese, R., Audureau, E., Cagnot, C., Marcellin, P., Guyader, D., Fontaine, H., Larrey, D., and De L\u00e9dinghen, V. (2017). Eradication of Hepatitis C Virus Infection in Patients with Cirrhosis Reduces Risk of Liver and Non-Liver Complications. Gastroenterology, 152.","DOI":"10.1053\/j.gastro.2016.09.009"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.3748\/wjg.v22.i4.1570","article-title":"Liver transplantation for viral hepatitis in 2015","volume":"22","author":"Ferrarese","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1053\/j.gastro.2015.05.010","article-title":"Ledipasvir and Sofosbuvir Plus Ribavirin for Treatment of HCV Infection in Patients with Advanced Liver Disease","volume":"149","author":"Charlton","year":"2015","journal-title":"Gastroenterology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/S1473-3099(16)00052-9","article-title":"Ledipasvir and sofosbuvir plus ribavirin in patients with genotype 1 or 4 hepatitis C virus infection and advanced liver disease: A multicentre, open-label, randomised, phase 2 trial","volume":"16","author":"Manns","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1002\/hep.27681","article-title":"Sofosbuvir compassionate use program for patients with severe recurrent hepatitis C after liver transplantation","volume":"61","author":"Forns","year":"2015","journal-title":"Hepatology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1002\/hep.29258","article-title":"Safety and efficacy of current direct-acting antiviral regimens in kidney and liver transplant recipients with hepatitis C: Results from the HCV-TARGET study","volume":"66","author":"Saxena","year":"2017","journal-title":"Hepatology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1880","DOI":"10.1002\/hep.27770","article-title":"Multicenter experience using simeprevir and sofosbuvir with or without ribavirin to treat hepatitis C genotype 1 after liver transplant","volume":"61","author":"Pungpapong","year":"2015","journal-title":"Hepatology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/j.jhep.2018.05.039","article-title":"Sofosbuvir\/velpatasvir for 12 weeks in genotype 1\u20134 HCV-infected liver transplant recipients","volume":"69","author":"Agarwal","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1002\/hep.28446","article-title":"Daclatasvir with sofosbuvir and ribavirin for hepatitis C virus infection with advanced cirrhosis or post-liver transplantation recurrence","volume":"63","author":"Poordad","year":"2016","journal-title":"Hepatology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1111\/liv.13193","article-title":"Impact of viral eradication with sofosbuvir-based therapy on the outcome of post-transplant hepatitis C with severe fibrosis","volume":"37","author":"Martini","year":"2017","journal-title":"Liver Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1111\/liv.13652","article-title":"Long-term follow-up of ribavirin-free DAA-based treatment in HCV recurrence after orthotopic liver transplantation","volume":"38","author":"Beinhardt","year":"2018","journal-title":"Liver Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.transproceed.2018.04.088","article-title":"Efficacy of Direct-acting Antivirals to Improve Clinical Condition, Fibrosis, and Liver Function in Liver Transplant Recipients Infected by Hepatitis C","volume":"51","year":"2019","journal-title":"Transplant. Proc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1002\/hep.29557","article-title":"Portal pressure and liver stiffness measurements in the prediction of fibrosis regression after sustained virological response in recurrent hepatitis C","volume":"67","author":"Mauro","year":"2018","journal-title":"Hepatology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1002\/lt.25424","article-title":"Improved Graft Survival After Liver Transplantation for Recipients with Hepatitis C Virus in the Direct-Acting Antiviral Era","volume":"25","author":"Cotter","year":"2019","journal-title":"Liver Transpl."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1111\/jvh.13039","article-title":"Improved liver transplant waitlist mortality and lower risk of disease progression among chronic hepatitis C patients awaiting liver transplantation after the introduction of direct-acting antiviral therapies in the United States","volume":"26","author":"Young","year":"2019","journal-title":"J. Viral Hepat."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1016\/j.jhep.2020.08.018","article-title":"EASL recommendations on treatment of hepatitis C: Final update of the series","volume":"73","author":"Pawlotsky","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"139","DOI":"10.15403\/jgld.2014.1121.272.100","article-title":"100% Sustained Virological Response and Fibrosis Improvement in Real-Life Use of Direct Acting Antivirals in Genotype-1b Recurrent Hepatitis C following Liver Transplantation","volume":"27","author":"Iacob","year":"2018","journal-title":"J. Gastrointest. Liver Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1111\/tid.12606","article-title":"The impact of directly acting antivirals on the enzymatic liver function of liver transplant recipients with recurrent hepatitis C","volume":"18","author":"Raschzok","year":"2016","journal-title":"Transpl. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1053\/j.gastro.2014.10.001","article-title":"Sofosbuvir and Ribavirin for Treatment of Compensated Recurrent Hepatitis C Virus Infection After Liver Transplantation","volume":"148","author":"Charlton","year":"2015","journal-title":"Gastroenterology"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Liu, A., Angirekula, M., Elhawary, A., Mara, K., Kulai, T., Leise, M., and Watt, K.D. (2023). Progression of fibrosis in liver transplant recipients with hepatitis C before and after sustained virologic response. Clin. Transplant., e15050.","DOI":"10.1111\/ctr.15050"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e13020","DOI":"10.1111\/tid.13020","article-title":"Evaluation of histological dynamics, kidney function and diabetes in liver transplant patients after antiviral treatment with direct-acting antivirals: Therapy of HCV-recurrence","volume":"21","author":"Teegen","year":"2019","journal-title":"Transpl. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.jhep.2018.02.012","article-title":"The efficacy of direct anti-HCV drugs improves early post-liver transplant survival and induces significant changes in waiting list composition","volume":"69","author":"Crespo","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1111\/jvh.12712","article-title":"Long-term outcomes of direct acting antivirals in post-transplant advanced hepatitis C virus recurrence and fibrosing cholestatic hepatitis","volume":"24","author":"Vukotic","year":"2017","journal-title":"J. Viral Hepat."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2087","DOI":"10.1097\/TP.0000000000003115","article-title":"The Impact of Direct-acting Antivirals on Overall Mortality and Tumoral Recurrence in Patients with Hepatocellular Carcinoma Listed for Liver Transplantation: An International Multicenter Study","volume":"104","author":"Gorgen","year":"2020","journal-title":"Transplantation"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1002\/lt.25744","article-title":"Direct-Acting Antivirals and Hepatocellular Carcinoma: No Evidence of Higher Wait-List Progression or Posttransplant Recurrence","volume":"26","author":"Boin","year":"2020","journal-title":"Liver Transpl."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/8\/1702\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:27:36Z","timestamp":1760128056000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/8\/1702"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,7]]},"references-count":31,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["v15081702"],"URL":"https:\/\/doi.org\/10.3390\/v15081702","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,7]]}}}