Premium
The impact of direct‐acting antiviral agents on liver and kidney transplant costs and outcomes
Author(s) -
Axelrod D. A.,
Schnitzler M. A.,
Alhamad T.,
Gordon F.,
Bloom R. D.,
Hess G. P.,
Xiao H.,
Nazzal M.,
Segev D. L.,
Dharnidharka V. R.,
Naik A. S.,
Lam N. N.,
Ouseph R.,
Kasiske B. L.,
Durand C. M.,
Lentine K. L.
Publication year - 2018
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14895
Subject(s) - medicine , serostatus , hazard ratio , hepatitis c , hepatitis c virus , gastroenterology , human immunodeficiency virus (hiv) , immunology , confidence interval , viral load , virus
Direct‐acting antiviral medications ( DAA s) have revolutionized care for hepatitis C positive ( HCV +) liver ( LT ) and kidney ( KT ) transplant recipients. Scientific Registry of Transplant Recipients registry data were integrated with national pharmaceutical claims (2007‐2016) to identify HCV treatments before January 2014 (pre‐ DAA ) and after (post‐ DAA ), stratified by donor (D) and recipient (R) serostatus and payer. Pre‐ DAA , 18% of HCV + LT recipients were treated within 3 years and without differences by donor serostatus or payer. Post‐ DAA , only 6% of D‐/R+ recipients, 19.8% of D+/R+ recipients with public insurance, and 11.3% with private insurance were treated within 3 years ( P < .0001). LT recipients treated for HCV pre‐ DAA experienced higher rates of graft loss (adjusted hazard ratio [ aHR ] 1.34 1.85 2.10 , P < .0001) and death ( aHR 1.47 1.68 1.91 , P < .0001). Post‐ DAA , HCV treatment was not associated with death ( aHR 0.34 0.67 1.32 , P = .25) or graft failure ( aHR 0.32 0.64 1.26 , P = .20) in D+R+ LT recipients. Treatment increased in D+R+ KT recipients (5.5% pre‐ DAA vs 12.9% post‐ DAA ), but did not differ by payer status. DAA s reduced the risk of death after D+/R+ KT by 57% ( 0.19 0.43 0.95 , P = .04) and graft loss by 46% ( 0.27 0.54 1.07 , P = .08). HCV treatment with DAA s appears to improve HCV + LT and KT outcomes; however, access to these medications appears limited in both LT and KT recipients.