Decreasing frequency and improved outcomes of hepatitis C-related liver transplantation in the era of direct-acting antivirals – a retrospective cohort study

Sumant S. Arora, Page Axley, Zunirah Ahmed, Sanjaya Satapathy, Robert Wong, Young Fang Kuo, Ashwani K. Singal

Research output: Contribution to journalArticle

Abstract

Benefit of direct-acting antivirals (DAA) for hepatitis C virus (HCV) on clinical outcomes is unclear. We examined temporal trends in liver transplant (LT) listings, receipt of LT, re-LT, and survival between pre-DAA (2009–2012) and DAA era (2013–2016) using UNOS database. Of 32 319 first adult LT, 15 049 (47%) were performed for HCV. Trends on listing, first LT, and of re-LT for HCV showed 23%, 20%, and 21% decrease in DAA compared to pre-DAA era (P < 0.0001). One-year liver graft and patient survival among HCV LT improved in DAA era (90% vs. 86% and 92% vs. 88%, respectively, P < 0.0001). Non-HCV LT showed no improvement in survival (89% vs. 89% and 92% vs. 92.4%, P = NS). On cox regression, compared to non-HCV LTs in DAA era, LT for HCV in pre-DAA era had worse patient survival (HR 1.56 [1.04–2.35]). The outcome was similar when compared to LTs for HCV in DAA era and for non-HCV in pre-DAA era. Burden of HCV-related LT waitlist and LT is declining in DAA era, with improved post-transplant outcomes, more so in later than earlier DAA era. Our findings negate recent Cochrane meta-analysis on DAA therapy and encourage studies to examine HCV clinical outcomes outside LT setting.

Original languageEnglish (US)
Pages (from-to)854-864
Number of pages11
JournalTransplant International
Volume32
Issue number8
DOIs
StatePublished - Aug 1 2019

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Hepatitis C
Liver Transplantation
Antiviral Agents
Cohort Studies
Retrospective Studies
Transplants
Hepacivirus
Liver
Viruses
Survival
Graft Survival
Meta-Analysis
Databases

All Science Journal Classification (ASJC) codes

  • Transplantation

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Decreasing frequency and improved outcomes of hepatitis C-related liver transplantation in the era of direct-acting antivirals – a retrospective cohort study. / Arora, Sumant S.; Axley, Page; Ahmed, Zunirah; Satapathy, Sanjaya; Wong, Robert; Kuo, Young Fang; Singal, Ashwani K.

In: Transplant International, Vol. 32, No. 8, 01.08.2019, p. 854-864.

Research output: Contribution to journalArticle

Arora, Sumant S. ; Axley, Page ; Ahmed, Zunirah ; Satapathy, Sanjaya ; Wong, Robert ; Kuo, Young Fang ; Singal, Ashwani K. / Decreasing frequency and improved outcomes of hepatitis C-related liver transplantation in the era of direct-acting antivirals – a retrospective cohort study. In: Transplant International. 2019 ; Vol. 32, No. 8. pp. 854-864.
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