Improved Outcomes in HCV Patients Following Liver Transplantation During the Era of Direct-Acting Antiviral Agents

Cholankeril, George; Li, Andrew A.; March, Katherine; Yoo, Eric R.; Kim, Dong‐Hee; Snyder, Heather; Gonzalez, Stevan A.; Younossi, Zobair M.

doi:10.1016/j.cgh.2017.08.020

Cited by 37 publications

(36 citation statements)

References 5 publications

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“…This finding is similar to that of a recently published retrospective analysis that showed significantly lower rates of death and graft loss in patients treated in the post‐DAA compared to those treated in the pre‐DAA era . Similarly, a 2018 retrospective study comparing 1‐year outcomes in the pre‐DAA and post‐DAA eras demonstrated significantly improved survival (91.9% vs. 89.8%) in HCV‐positive patients transplanted in the post‐DAA era, which was associated with a 34% reduction in 1‐year mortality compared to the pre‐DAA era . Our results now show that excellent, equivalent graft survival extends to at least to 3 years in this transplant population.…”

Section: Discussionsupporting

confidence: 86%

Increasing Utilization and Excellent Initial Outcomes Following Liver Transplant of Hepatitis C Virus (HCV)‐Viremic Donors Into HCV‐Negative Recipients: Outcomes Following Liver Transplant of HCV‐Viremic Donors

et al. 2019

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Direct‐acting antiviral (DAA) therapy has altered the frequency and outcome of liver transplantation (LT) for hepatitis C virus (HCV). The high efficacy and tolerability of DAA therapy has also created a rationale for utilizing HCV‐viremic (HCV‐RNA–positive) donors, including into HCV‐negative recipients. We examined trends in frequency of organ utilization and graft survival in recipients of HCV‐viremic donors (HCV‐RNA positive as measured by nucleic acid testing [NAT]). Data were collected from the Scientific Registry of Transplant Recipients (SRTR) on adult patients who underwent a primary, single‐organ, deceased donor LT from January 1, 2008 to January 31, 2018. Outcomes of HCV‐negative transplant recipients (R–) who received an allograft from donors who were HCV‐RNA positive (DNAT+) were compared to outcomes for R– patients who received organs from donors who were HCV‐RNA negative (DNAT–). There were 11,270 DNAT–/R–; 4,748 DNAT–/R+; 87 DNAT+/R–; and 753 DNAT+/R+ patients, with 2‐year graft survival similar across all groups: DNAT–/R– 88%; DNAT–/R+ 88%; DNAT+/R– 86%; and DNAT+/R+ 90%. Additionally, there were 2,635 LTs using HCV antibody‐positive donors (DAb+): 2,378 DAb+/R+ and 257 DAb+/R–. The annual number of DAb+/R– transplants increased from seven in 2008 to 107 in 2017. In the post‐DAA era, graft survival improved for all recipients, with 3‐year survival of DAb+/R– patients and DAb+/R+ patients increasing to 88% from 79% and to 85% from 78%, respectively. Conclusion: The post‐DAA era has seen increased utilization of HCV‐viremic donor livers, including HCV‐viremic livers into HCV‐negative recipients. Early graft outcomes are similar to those of HCV‐negative recipients. These results support utilization of HCV‐viremic organs in selected recipients both with and without HCV infection.

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Section: Discussionsupporting

confidence: 86%

Increasing Utilization and Excellent Initial Outcomes Following Liver Transplant of Hepatitis C Virus (HCV)‐Viremic Donors Into HCV‐Negative Recipients: Outcomes Following Liver Transplant of HCV‐Viremic Donors

et al. 2019

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“…Conversely, although access to medication remained a problem, in the DAA era HCV‐positive liver transplant recipients have had improved early graft survival compared with those treated in the pre‐DAA era . A recent retrospective analysis demonstrated significantly improved 1‐year survival rates (91.9% versus 89.8%) in HCV‐positive patients transplanted in the DAA era compared with the pre‐DAA era . Our results, on a similar but larger cohort, show that the excellent graft survival extends to at least 3 years in this transplant population and is congruent with the improvement noted in the ELTR study, which demonstrated improved 3‐year survival of LT recipients with HCV‐related liver disease from 65.1% to 76.9% in the DAA era .…”

Section: Discussionsupporting

confidence: 83%

“…The poor efficacy and tolerability of peginterferon ± ribavirin‐based regimens in the pre‐DAA era decreased patient and graft survival for HCV‐positive patients with an overall 10% difference at 10 years when compared with those transplanted for other indications . However, more recent studies have indicated that patients treated in the DAA era may have improved short‐term graft survival compared with those treated in the pre‐DAA era . In addition, a recent cohort study of the European Liver Transplant Registry (ELTR) demonstrated improved 3‐year survival of LT recipients with HCV‐related liver disease in the DAA era .…”

mentioning

confidence: 99%

Improved Graft Survival After Liver Transplantation for Recipients With Hepatitis C Virus in the Direct‐Acting Antiviral Era

et al. 2019

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Highly effective direct‐acting antiviral (DAA) therapy has transformed outcomes of liver transplantation in hepatitis C virus (HCV) patients. We examined longer‐term outcomes in HCV‐positive recipients in the DAA era and analyzed the Scientific Registry of Transplant Recipients for primary adult, single‐organ, nonfulminant liver transplant recipients in the United States from January 1, 2008 to June 30, 2018. Graft loss was compared among HCV‐positive liver transplant recipients who received either an HCV‐negative or HCV‐positive donor (donor [D]–/recipient [R]+; D+/R+) and HCV‐negative liver transplant recipients who received a HCV‐negative donor (D–/R–). The groups were further divided between the pre‐DAA and DAA eras. There were 52,526 patients included: 31,193 were D–/R– patients; 18,746 were D–/R+ patients; and 2587 were D+/R+ patients. The number of D–/R+ transplants decreased from 2010 in 2008 to 1334 in 2017, with this decline particularly noticeable since 2015. D–/R+ patients in the DAA era (n = 7107) were older, had higher rates of hepatocellular carcinoma, and lower Model for End‐Stage Liver Disease scores than those in the pre‐DAA era. Graft survival improved for all recipients in the DAA era but improved most dramatically in HCV‐positive recipients: D–/R+ 1‐year survival was 92.4% versus 88.7% and 3‐year survival was 83.7% versus 77.7% (DAA versus pre‐DAA era, respectively) compared with D–/R– 1‐year survival of 92.7% versus 91.0% and 3‐year survival of 85.7% versus 84.0% (DAA versus pre‐DAA era, respectively). The magnitude of improvement in 3‐year graft survival was almost 4‐fold greater for D–/R+ patients. The 3‐year survival for D+/R+ patients was similar to HCV‐negative patients. In conclusion, the number of liver transplants for HCV has decreased by more than one‐third over the past decade. Graft survival among HCV‐positive recipients has increased disproportionately in the DAA era with HCV‐positive recipients now achieving similar outcomes to non‐HCV recipients.

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“…However, the approval of second-generation direct-acting antiviral (DAA) agents in late 2013 has already had a positive impact by improving the short-term liver transplant (LT) recipient and graft survival rates. 1 Furthermore, data through 2015 demonstrated a decline in the number of HCV-related LT waitlist registrations and LT surgeries following the introduction of DAA-based regimens. 2,3 Despite the downtrend, primary diagnosis of HCV remained the most common cause for liver transplantation in the United States until the end of 2015.…”

mentioning

confidence: 99%

Alcoholic Liver Disease Replaces Hepatitis C Virus Infection as the Leading Indication for Liver Transplantation in the United States

Cholankeril

Ahmed

2018

Clinical Gastroenterology and Hepatology

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227

164

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Improved Outcomes in HCV Patients Following Liver Transplantation During the Era of Direct-Acting Antiviral Agents

Cited by 37 publications

References 5 publications

Increasing Utilization and Excellent Initial Outcomes Following Liver Transplant of Hepatitis C Virus (HCV)‐Viremic Donors Into HCV‐Negative Recipients: Outcomes Following Liver Transplant of HCV‐Viremic Donors

Increasing Utilization and Excellent Initial Outcomes Following Liver Transplant of Hepatitis C Virus (HCV)‐Viremic Donors Into HCV‐Negative Recipients: Outcomes Following Liver Transplant of HCV‐Viremic Donors

Improved Graft Survival After Liver Transplantation for Recipients With Hepatitis C Virus in the Direct‐Acting Antiviral Era

Alcoholic Liver Disease Replaces Hepatitis C Virus Infection as the Leading Indication for Liver Transplantation in the United States

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