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Genetic Test Could Predict Transplant Success in People with Hep C, Cirrhosis

Lack of viable donors still a problem with fatty liver disease and obesity rising.

A saliva test could identify genetic markers that indicate which people with hepatitis C and cirrhosis will benefit from certain treatments.

Researchers say this test could help doctors predict outcomes after treating hepatitis C, and decrease the need for liver transplants.

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“Our findings further the move toward precision medicine, because we can potentially use a person’s genetic makeup to identify individuals who can benefit most from hepatitis C treatment, even at a very late stage in the progression of their liver disease,” Dr. Winston Dunn, lead author, and an associate professor at the University of Kansas Medical Center, said in a statement.

The study was presented this weekend at Digestive Disease Week 2017.

“This information will help us minimize the need for liver transplantations,” Dunn said on a conference call.

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“It’s very simple to collect the genetic material by doing a cheek swab,” Dunn told Healthline.

However, the test is not currently available as a stand-alone evaluation and only available in labs right now, he noted.

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Read more: Get the facts on hepatitis C »

Better predicting

Although most people with hepatitis C virus can be cured, about 5 percent have more serious liver damage even after the virus is gone.

Dunn said this test would help determine who would have more success from a liver transplant.

Dunn’s team examined part of the PNPLA3 gene, the Rs738409 single nucleotide polymorphism (RSP), a variation in a pair of the gene’s DNA.

It can show a significant risk factor for both alcoholic liver disease and nonalcoholic fatty liver disease. There are three genotypes a person can have in the gene: CC, CG, or GG.

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The researchers followed 32 people who had decompensated cirrhosis and were in that aforementioned 5 percent. These participants initially achieved a sustained virologic response and were virus-free.

Between 12 and 48 weeks later, researchers tracked their progress according to the Model for End-Stage Liver Disease (MELD) and the Child-Turcotte-Pugh (CTP) rankings.

Those scores are used to determine the severity of chronic liver disease. They found that five out of 16 patients with CG or GG genotypes had worse MELD or CTP scores. One of the people with the CC genotype had worse MELD or CTP scores.

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Dunn said that the findings suggest that screening for the Rs738409 CG and GG genotypes in people with hepatitis C with decompensated cirrhosis can pinpoint people who won’t recover after they are cured of the virus.

“Until now, we have not had a method to distinguish between the individuals who would recover given equal severity in baseline disease,” he said.

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He said this will help providers deliver more customized treatment plans based on the individual needs of patients.

In the future, Dunn wants to better understand the mechanisms that explain why having the certain genotypes can lead to poorer outcomes.

Read more: The latest on hepatitis C vaccines »

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Why curing isn’t enough

Dr. Richard Gilroy, who heads up the Liver Transplantation Program at Intermountain Medical Center in Utah, said the results of the latest study are promising.

However, people need to keep in mind that people with hepatitis C often have more than one health condition — so curing hepatitis isn’t always enough to save their lives.

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“There are people we treat for hepatitis C that will not be out of the woods,” he explained.

Liver damage can still progress even after hepatitis is removed from one’s system.

“Hep C can clear, but you may still develop cirrhosis or liver cancer,” he said, adding that the biomarker studied can also show a person’s risk for liver cancer.

Dr. Douglas Dieterich, a professor of liver diseases with The Mount Sinai Hospital in New York, said the test is a great way to tell who can recover compared with who is past the point of no return and has to stay on the liver transplant list.

He said he tests for fatty liver disease in people with hep C and finds that those with both conditions are usually the ones who do not get better.

Gilroy added that the United States is experiencing a major health crisis due to obesity and fatty liver disease.

Even if a transplant may save a person’s life, it’s going to be hard to get enough organs because those diseases are affecting so many potential donors, he noted.

Read more: Hepatitis C outbreak in Appalachian states blamed on poverty, drug use »

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