Retransplantation outcomes for hepatitis C in the United States before and after direct-acting antiviral introduction

Abstract

The success of direct‐acting antiviral (DAA) therapy has led to near‐universal cure for patients chronically infected with hepatitis C virus (HCV) and improved post–liver transplant (LT) outcomes. We investigated the trends and outcomes of retransplantation in HCV and non‐HCV patients before and after the introduction of DAA. Adult patients who underwent re‐LT were identified in the Organ Procurement and Transplantation Network/United Network for Organ Sharing database. Multiorgan transplants and patients with >2 total LTs were excluded. Two eras were defined: pre‐DAA (2009‐2012) and post‐DAA (2014‐2017). A total of 2112 re‐LT patients were eligible (HCV: n = 499 pre‐DAA and n = 322 post‐DAA; non‐HCV: n = 547 pre‐DAA and n = 744 post‐DAA). HCV patients had both improved graft and patient survival after re‐LT in the post‐DAA era. One‐year graft survival was 69.8% pre‐DAA and 83.8% post‐DAA (P < .001). One‐year patient survival was 73.1% pre‐DAA and 86.2% post‐DAA (P < .001). Graft and patient survival was similar between eras for non‐HCV patients. When adjusted, the post‐DAA era represented an independent positive predictive factor for graft and patient survival (hazard ratio [HR]: 0.67; P = .005, and HR: 0.65; P = .004) only in HCV patients. The positive post‐DAA era effect was observed only in HCV patients with first graft loss due to disease recurrence (HR: 0.31; P = .002, HR 0.32; P = .003, respectively). Among HCV patients, receiving a re‐LT in the post‐DAA era was associated with improved patient and graft survival.

Outcomes after liver transplantation using deceased after circulatory death donors: A comparison of outcomes in the UK and the US

“…In addition, given that HCV status may impact transplant and retransplant outcomes, sensitivity analyses were performed stratifying by country, HCV-related liver disease and HCV serostatus. 22 These results were included in the supplemental section. All statistical analyses were performed using R Core Team…”

“…For purposes of comparison all analyses were repeated for patients receiving DBD liver transplants. In addition, given that HCV status may impact transplant and retransplant outcomes, sensitivity analyses were performed stratifying by country, HCV‐related liver disease and HCV serostatus 22 . These results were included in the supplemental section.…”

A Focused Review on Recent Advances in the Diagnosis and Treatment of Viral Hepatitis

“…In patients with histopathological evidence of established graft cirrhosis, the only treatment option is re-transplant which accounts for only 10% of all liver transplants and has overall worse outcomes than primary transplants. Although the high cost, historically poor outcomes, and limited availability of hepatic transplants have made re-transplant a contested topic, the application of DAAs during re-transplant has led to overall improved patient and graft survival rates, similar to those of non-HCV re-transplant recipients [ 93 ].…”