Scientists Create Predictive Calculator to Aid Liver Transplant Decisions

A new online scoring tool for the first time gives doctors a numerical prediction of the likelihood that a particular patient with hepatitis C-associated decompensated cirrhosis will improve if prescribed direct-acting antivirals (DAAs).

That score, based on five metrics, could become an important factor in decisions over whether, and when, to recommend liver transplantation. The new method is outlined in a study in the journal Gastroenterology.

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DAAs have been a breakthrough in the treatment of hepatitis C. But patients with hepatitis C-related decompensated cirrhosis who are treated with DAAs sometimes still face death if they don’t receive a liver transplant. That’s true even when patients’ survival chances seem to be improving under the standard method of predicting cirrhosis mortality, known as a Child-Pugh-Turcotte (CPT) score.

Researchers sought to solve that problem by giving physicians and patients a better understanding of whether DAA is likely to work in a particular case. The new calculation was developed via a retrospective analysis of data from four clinical trials evaluating the DAA sofosbuvir.

Corresponding author Michael P. Curry, M.D., an associate professor of medicine at Harvard Medical School and the director of hepatology at Beth Israel Deaconess Medical Center, said the five factors identified as important to predicting the success of DAA therapy were fairly straightforward.

“There was nothing in the predictive model that surprised us, as most of these factors would essentially be associated with worse liver disease, and patients with worse liver disease are less likely to revert,” he told Healthcare Analytics News™.

Those factors included body mass index, the presence of encephalopathy or ascites, serum levels of albumin and levels of alanine aminotransferase (ALT).

Rather than identifying surprising factors that contribute to the success or failure of the therapy, the tool gives a percentage score, something much more concrete than gut instinct, Curry said.

The measure is known as a “BE3A” score, named after the first letters of each of its five components. The calculator can be accessed online for free. Patients who score a four or five on the BE3A scale are deemed to have a high likelihood of improvement over the course of 36 weeks on DAA therapy. Patients with a BE3A score of zero or one have just a 25 percent chance, or less, of improving.

Curry said one shortcoming of the calculator is that the studies used to devise the scoring system only tracked patients for 36 weeks, meaning the calculator’s predictions only provide a window into the effects of treatment over that nine-month time frame. The main use of the calculator will be to help physicians decide whether patients are good candidates for liver transplants, as the score delivers an accurate idea of whether the patient will improve with medication alone.

“If the model predicts a really good chance or recovering liver function, then one would treat (with DAA), as improvement in liver function after treatment might negate the need for transplant,” Curry said. “If the model does not predict a good chance of improvement in liver function, then transplant followed by treatment would be the way to go.”

Physicians treating patients who aren’t good candidates for transplant wouldn’t need the score, Curry explained, because treatment would be their only option.

The study is titled, “Baseline Factors Associated With Improvements in Decompensated Cirrhosis After Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection.” It was published in Gastroenterology’s June issue.

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