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Acute cellular rejection in hepatitis C recipients following liver transplantation in the era of direct‐acting antivirals: chronological analysis of the United Network for Organ Sharing database
Author(s) -
Tanaka Tomohiro,
Voigt Michael D.
Publication year - 2019
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.645
Subject(s) - united network for organ sharing , medicine , liver transplantation , hepatitis c , organ transplantation , transplantation , immunology
Interferon (IFN) treatment for liver transplant (LT) recipients with hepatitis C virus (HCV) increases acute cellular rejection (ACR) and worsens graft and patient survival. It is unknown if direct‐acting antivirals (DAAs) affect rejection rates or post‐transplant survival. Method The United Network for Organ Sharing STAR files of December 2017 ( n = 25,916) were analyzed. Results Compared with non‐HCV‐LT, HCV‐LT survival was worse in the IFN‐era (2007–2008) and IFN+DAA‐era (2011), but not in the DAA‐era (2014–2015). ACR6m rate has been less frequent in newer eras and was lower in HCV‐LT than in non‐HCV‐LT in both the DAA‐era (6.9% vs. 9.3%, P < 0.001) and in the IFN+DAA‐era (8.8% vs. 11.8%, P = 0.001), but not in the IFN‐era (10.8% vs. 11.0%, P = 0.39). HCV‐LT recipients who had ACR6m had worse 2‐year survival than those without ACR6m, in the IFN‐era (80.0% vs. 88.4%, P < 0.0001) and in the IFN+DAA‐era (81.4% vs. 89.2%, P < 0.01) but not in the DAA‐era (90.4% vs. 93.2%, P = 0.085). Cox proportional hazard model identified ACR6m as independent risk factor for mortality in HCV‐LT in the IFN‐era (HR = 1.88, P ≤ 0.001) and in the IFN+DAA‐era (HR = 1.84, P = 0.005), but not in the DAA‐era ( P = n.s.). Conclusions Two‐year survival of HCV‐LT recipients were significantly better in the DAA‐era; these were associated with reduced rate and impact of ACR6m.