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Trends in liver transplantation for hepatitis C in a country with reduced access to direct‐acting antiviral agents
Author(s) -
Dirchwolf Melisa,
Marciano Sebastián,
Giunta Diego H.,
PosadasMartínez Maria L.,
Biggins Scott W.,
Ruf Andrés E.
Publication year - 2018
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13230
Subject(s) - medicine , liver transplantation , hepatitis c , liver disease , cirrhosis , transplantation , hepatitis c virus , gastroenterology , hepatocellular carcinoma , incidence (geometry) , primary biliary cirrhosis , immunology , virus , physics , optics
Background Hepatitis C virus ( HCV )‐related cirrhosis is a leading indication for liver transplantation ( LT ) worldwide. Access to effective HCV treatment is inequitable globally. We aimed to analyze whether the introduction of effective HCV treatment caused an impact in LT trends in a middle‐income country. Methods Cross‐sectional analysis of all adult patients who were listed/received a LT in Argentina for HCV , alcohol‐related liver disease ( ALD ), or autoimmune hepatitis/primary biliary cirrhosis ( AIH / PBC ) from 2007 to 2017. Joinpoint regression analysis was used to identify changes in the cumulative incidence rates in waiting list ( WL ) registration, WL mortality, and LT . Results Liver transplantation WL for HCV increased significantly between 2007 and 2014, with an annual percentage change ( APC ) +7.8%, P = .01, followed by a downward slope from 2014 to 2017 with an APC −9.8%, P = .1. There were no significant changes in WL mortality. LT trends remained stable. LT for HCV without MELD exception points for HCC decreased ( APC −6.6%, P = .01), whereas LT for HCV with HCC exception points increased ( APC +11.1, P = .01) during the study period. Conclusion Waiting list and LT for HCV without HCC decreased, whereas LT for HCV and HCC increased; this may be related to selective antiviral treatment access for patients with advanced fibrosis.