TY - JOUR
T1 - Improved Graft Survival After Liver Transplantation for Recipients With Hepatitis C Virus in the Direct-Acting Antiviral Era
AU - Cotter, Thomas G.
AU - Paul, Sonali
AU - Sandıkçı, Burhaneddin
AU - Couri, Thomas
AU - Bodzin, Adam S.
AU - Little, Ester C.
AU - Sundaram, Vinay
AU - Charlton, Michael
N1 - Publisher Copyright:
Copyright © 2019 by the American Association for the Study of Liver Diseases
PY - 2019/4
Y1 - 2019/4
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85063459590&partnerID=8YFLogxK
U2 - 10.1002/lt.25424
DO - 10.1002/lt.25424
M3 - Article
C2 - 30716208
AN - SCOPUS:85063459590
SN - 1527-6465
VL - 25
SP - 598
EP - 609
JO - Liver Transplantation
JF - Liver Transplantation
IS - 4
ER -