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Decreasing frequency and improved outcomes of hepatitis C‐related liver transplantation in the era of direct‐acting antivirals – a retrospective cohort study
Abstract
Benefit of direct-acting antivirals (DAA) for hepatitis C virus (HCV) on clinical outcomes is unclear. We examined temporal trends in liver transplant (LT) listings, receipt of LT, re-LT, and survival between pre-DAA (2009-2012) and DAA era (2013-2016) using UNOS database. Of 32 319 first adult LT, 15 049 (47%) were performed for HCV. Trends on listing, first LT, and of re-LT for HCV showed 23%, 20%, and 21% decrease in DAA compared to pre-DAA era (P < 0.0001). One-year liver graft and patient survival among HCV LT improved in DAA era (90% vs. 86% and 92% vs. 88%, respectively, P < 0.0001). Non-HCV LT showed no improvement in survival (89% vs. 89% and 92% vs. 92.4%, P = NS). On cox regression, compared to non-HCV LTs in DAA era, LT for HCV in pre-DAA era had worse patient survival (HR 1.56 [1.04-2.35]). The outcome was similar when compared to LTs for HCV in DAA era and for non-HCV in pre-DAA era. Burden of HCV-related LT waitlist and LT is declining in DAA era, with improved post-transplant outcomes, more so in later than earlier DAA era. Our findings negate recent Cochrane meta-analysis on DAA therapy and encourage studies to examine HCV clinical outcomes outside LT setting.
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Patients with HCV and a detectable viral load without significant liver fibrosis may be treated after lung transplant.
“patients with a detectable HCV viral load without significant liver fibrosis may be treated after lung transplant.(79, 80)”
From Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. (2021) · cites this paper as [80]
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Sorted by citations
Leard, L. E., Holm, A. M., Valapour, M., Glanville, A. R., Attawar, S., Aversa, M., Campos, S. V., Christon, L. M., Cypel, M., Dellgren, G., et al. (2021) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2021.07.005 · Cited by 821
“Ideally, patients with HCV should be treated prior to lung transplant; however, patients with a detectable HCV viral load without significant liver fibrosis may be treated after lung transplant.(79,80) Human immunodeficiency virus (HIV): Case series have demonstrated comparable 1-year and 5-year survival for HIV-infec…”
Background
Metadata
- Authors
- Arora, S. S., Axley, P., Ahmed, Z., Satapathy, S. K., Wong, R., Kuo, Y., & Singal, A. K.
- Affiliations
- University of Iowa (US)
- University of Alabama at Birmingham (US)
- University of Tennessee Health Science Center (US)
- Alameda Health System (US)
- The University of Texas Medical Branch at Galveston (US)
- University of South Dakota (US)
- Venue
- Transplant International
- Publisher
- Frontiers Media SA
- Published
- 2019-03-26
- Volume
- 32
- Issue
- 8
- Pages
- 854-864
- ISSN
- 0934-0874 (ISSN-L)
- 1432-2277
- OpenAlex
- W2921118528
- Cited by
- 24
- References
- 1
- Citations by year
- 2026: 1 · 2024: 2 · 2023: 6 · 2022: 6 · 2021: 7 · 2020: 2
- FWCI
- 2.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Transplant International (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American College of Gastroenterology
- Topics
- Health Sciences › Medicine › Hepatology › Hepatitis C virus research
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Keywords
- hepatitis C virus, liver transplantation, direct-acting antivirals, transplant waiting list, retransplantation, graft survival, patient survival, temporal trends, HCV-related liver disease
- MeSH terms
- Adult, Antiviral Agents, Female, Graft Survival, Carcinoma, Hepatocellular, Humans, Immunosuppression Therapy, Liver Cirrhosis, Liver Neoplasms, Male, Middle Aged, Tissue and Organ Procurement, Registries, Reoperation, Retrospective Studies, Time Factors, Waiting Lists, Proportional Hazards Models, Liver Transplantation, Hepacivirus, Treatment Outcome, Hepatitis C, Chronic
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