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Reduction in liver transplant wait‐listing in the era of direct‐acting antiviral therapy
Author(s) -
Flemming Jennifer A.,
Kim W. Ray,
Brosgart Carol L.,
Terrault Norah A.
Publication year - 2017
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.28923
Subject(s) - medicine , hepatocellular carcinoma , gastroenterology , hepatitis c virus , hepatology , cirrhosis , hepatitis c , liver disease , liver function , immunology , virus
Direct‐acting antiviral (DAA) therapy, recently approved for patients with decompensated cirrhosis (DC) secondary to hepatitis C virus (HCV), is associated with improved hepatic function. We analyzed trends in liver transplant (LT) wait‐listing (WL) to explore potential impact of effective medical therapy on WL registration. This is a cohort study using the Scientific Registry of Transplant Recipients database from 2003 to 2015. A total of 47,591 adults wait‐listed for LT from HCV, hepatitis B virus (HBV), and nonalcoholic steatohepatitis (NASH) were identified. LT indication was defined as DC if the Model for End‐Stage Liver Disease (MELD) at WL was ≥15 or hepatocellular carcinoma (HCC). Era of listing was divided into interferon (IFN; 2003‐2010), protease inhibitor (PI; 2011‐2013), and direct‐acting antiviral (DAA; 2014‐2015). Annual standardized incidence rates of WL were analyzed using Poisson regression. Adjusted incidences of LT WL for DC in HCV patients decreased by 5% in the PI era ( P = 0.004) and 32% in the DAA era ( P < 0.001) compared to the IFN era. Listing for DC in HBV also decreased in the PI (–17%; P = 0.002) and DAA eras (–24%; P < 0.001). Conversely, WL for DC in NASH increased by 41% in the PI era ( P < 0.001) and 81% in the DAA era ( P < 0.001). WL for HCC in both the HCV and NASH populations increased in both the PI and DAA eras ( P < 0.001 for all) whereas HCC WL in HBV remained stable ( P > 0.05 for all). Conclusion : The rate of LT WL for HCV complicated by DC has decreased by over 30% in the era of DAA therapy. Further reductions in WL are anticipated with increased testing, linkage to care, and access to DAA therapy. (H epatology 2017;65:804‐812).