Liver transplant listing for hepatitis C‐associated cirrhosis and hepatocellular carcinoma has fallen in the United Kingdom since the introduction of direct‐acting antiviral therapy

Vaziri, Arash; Gimson, Alexander; Agarwal, Kosh; Aldersley, Mark; Bathgate, Andrew; MacDonald, Douglas; McPherson, Stuart; Mutimer, David; Gelson, William

doi:10.1111/jvh.13022

Cited by 21 publications

(21 citation statements)

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“…Through linked data, we identified a decline in HCV-associated liver transplant rates after 2014, consistent with unlinked published data for England [2,8] and internationally [9-11]. A separate study within the UK [8], using unlinked data, reported registered transplants for patients with HCV-related cirrhosis fell from 10.5% in 2013 to 4.7% in 2016.…”

Section: Discussionsupporting

confidence: 80%

“…Since the expansion of treatment with DAAs in England, a 43% drop in the number of liver transplant registrations has been recorded for individuals with post-HCV cirrhosis [2]. Vaziri et al reported that the proportion of liver transplants attributed to HCV-associated cirrhosis fell from 10.5% to 4.7% between 2013 and 2016 and the proportion of liver transplants for cancer-associated HCV fell from 46.4% to 33.7% over the same period [8]. Similar results have been found in Italy, the United States (US) and Argentina [9-11].…”

Section: Introductionmentioning

confidence: 99%

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Monitoring liver transplant rates in persons diagnosed with hepatitis C: a data linkage study, England 2008 to 2017

et al. 2019

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Liver transplantation is an important measure of burden from hepatitis C virus (HCV)associated liver disease. Aims: To describe transplant rates and survival in individuals with HCV infection from 2008 to 2017 in England through data linkage. Methods: This is a retrospective observational cohort study. Laboratory reports of HCV infection were linked to the Liver Transplant Registry for individuals aged 15 years and over, first diagnosed between 1998 and 2017. We estimated age-sex standardised incidence rates and used Poisson regression to investigate predictors of liver transplantation and test for a change in incidence after introduction of direct-acting antivirals (DAAs) in 2014. Kaplan-Meier survival analysis was used to calculate post-transplant survival rates. Results: Of 124,238 individuals diagnosed with HCV infection, 1,480 were registered and 1,217 received a liver transplant. Of individuals registered, 1,395 had post-HCV cirrhosis and 636 had hepatocellular carcinoma (618 also had post-HCV cirrhosis). Median time from HCV diagnosis to transplant was 3.4 years (interquartile range: 1.3-6.8 years). Liver transplant rates were lower 2014-17 compared with 2011-13 (incidence rate ratio: 0.64; 95% confidence interval: 0.55-0.76). Survival rates were 93.4%, 79.9% and 67.9% at 1, 5 and 10 years, respectively. Data linkage showed minimal under-reporting of HCV in the transplant registry. Conclusion: In the post-DAA era, liver transplant rates have fallen in individuals with HCV infection, showing early impact of HCV treatment scale-up; but the short time from HCV diagnosis to liver transplant suggests late diagnosis is a problem. License, supplementary material and copyright This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence and indicate if changes were made.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Monitoring liver transplant rates in persons diagnosed with hepatitis C: a data linkage study, England 2008 to 2017

et al. 2019

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“…A fall in ESLD and HCC incidence was expected, as progression to liver disease is prevented by successful HCV treatment, the rates of which have increased since the phasing out of interferon‐based treatments and the introduction of DAAs in 2014, and as Operational Delivery Networks (who are responsible for local treatment decisions for persons with HCV) have increased case finding to achieve treatment quotas. Similar declines have been observed in liver transplant rates in persons with HCV, and although not significant a reduction in liver disease mortality rates has also been observed . The lag in HCC admission incidence reduction, when compared to ESLD admission incidence, could be due to the former having more advanced liver disease.…”

Section: Discussionsupporting

confidence: 58%

“…As the UK has signed up to the WHO global strategy for elimination of viral hepatitis as a significant public health threat by 2030 and the National Health Service (NHS) is ramping up HCV treatment rates nationally, it is important to benchmark the burden of HCV‐associated disease in the pre‐DAA era and monitor the evolution of HCV‐associated liver disease following their introduction. While there has been some work to show the positive initial impact of DAAs on HCV‐associated burden of disease in the UK, the incidence of ESLD and HCC, based on NHS Hospital Episode Statistics (HES) inpatient care data, has continued to increase post‐DAA introduction . However, it is unknown whether this increase is a true reflection of the current burden or influenced by changes in reporting of HCV within HES, as this methodology relies on HCV diagnosis been recorded on a patient's record.…”

Section: Introductionmentioning

confidence: 99%

Data linkage to monitor hepatitis C‐associated end‐stage liver disease and hepatocellular carcinoma inpatient stays in England

Ireland

Simmons

Hickman

et al. 2019

Journal of Viral Hepatitis

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Persons with chronic hepatitis C (HCV) infection are at increased risk of end‐stage liver disease (ESLD) and hepatocellular carcinoma (HCC). The impact of hepatitis treatment scale‐up and elimination strategies on ESLD and HCC incidence is a critical measure of progress towards WHO targets. Data from national laboratory surveillance of HCV diagnoses were linked to inpatient care records in Hospital Episode Statistics (HES). For persons first diagnosed with HCV between 1998 and 2016, we describe the characteristics of those with ESLD and HCC and estimate incidence. Of persons diagnosed with HCV between 1998 and 2016 (104 674), 9.1% (9525) had an admission for ESLD and 2.5% (2610) for HCC. The majority of persons with ESLD and HCC were male (70.7% and 82.7%) and of white ethnicity (89.9% and 82.7%). Crude incidence of ESLD and HCC admission was 10.4 and 3.2 per 1000 person‐years, respectively. When compared to 2011‐2013, incidence of ESLD and HCC admissions in 2014‐2017 were lower (ESLD incidence rate ratio [IRR]: 0.81; 95% Confidence interval [CI]: 0.76‐0.86; HCC IRR: 0.90; 95% CI: 0.82‐1.00, P = .045). Data linkage showed considerable underreporting of HCV in HES coding for ESLD and HCC (16.0% and 11.3%, respectively). In conclusion, we found a decline in incidence of ESLD and HCC‐related inpatient admissions since 2011‐2013. Linked analysis is required for the continued monitoring of ESLD and HCC inpatient incidence. However, HES data quality issues around completeness of identifiers contribute to uncertainty in linkage and may limit our ability to robustly monitor progress towards WHO elimination goals.

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“…One-half of the HCC cases among the three-fold increase in HCC incidence between 1975 and 2007 in the US can be attributed to the aging chronic HCV population. 2 Although there are indications that DAAs may slow progression to HCC, 20,21 there remains a vast population of HCC patients that could potentially benefit from treatment of their chronic HCV infections.…”

Section: Discussionmentioning

confidence: 99%

Impact of Direct Acting Antivirals on Survival in Patients with Chronic Hepatitis C and Hepatocellular Carcinoma

Kamp

Sellers

Stein

et al. 2019

Preprint

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26Direct-acting antiviral use is associated with increased survival in hepatitis C-related 27 hepatocellular carcinoma patients. Patients treated with direct-acting antiviral who achieved 28 hepatitis C cure had additionally increased survival versus those treated with direct-acting 29 antiviral who did not achieve hepatitis C cure. This study supports the use of direct-acting 30 antiviral for hepatitis C treatment in hepatocellular carcinoma patients. Abbreviations 53 DAA: Direct-acting antivirals; SVR12: 12-week sustained virologic response; HCC: 54 hepatocellular carcinoma; HCV: hepatitis c virus; OS: median overall survival; AJCC: American 55 Joint Committee on Cancer stage; MELD: Model for end stage liver disease; HR: hazard ratio 4 56 Abstract: 57 Background: To investigate the impact of direct-acting antivirals (DAA) and 12-week sustained 58 viral response (SVR12) in patients with hepatocellular carcinoma (HCC) and chronic hepatitis C 59 virus (HCV) infection. Methods: Retrospective analysis of HCC patients diagnosed from 2005 60 to 2016 at an urban tertiary-care hospital. Kaplan-Meier curves and multivariable Cox 61 proportional hazards models were used to assess survival. Results: 969 patients met inclusion 62 criteria. 478 patients received interventional oncology treatment (catheter-based therapies, 63 ablation or combination locoregional therapies), 141 received supportive care (palliative or no 64 treatment), 125 underwent liver transplantation, 112 had tumor resection and 94 received 65 chemotherapy or radiation as their primary treatment. Median overall survival of the cohort was 66 24.2 months (95% CI: 20.9-27.9). 470 patients had HCV (56%). 123 patients received DAA 67 therapies for HCV (26.2%), 83 of whom achieved SVR12 (68%). HCV-positive and HCV-68 negative patients had similar survival (20.7 months vs 17.4 months, p=0.22). Patients receiving 69 DAA therapy had an overall survival of 71.8 months (CI: 39.5-not reached) vs 11.6 months (CI: 70 9.8-14.5) for patients without DAA therapy (p<0.0001). DAA patients who achieved SVR12 had 71 an overall survival of 75.6 months (CI: 49.2-not reached) vs the non-SVR12 group (26.7 months, 72 CI: 13.7-31.1, p<0.0001). Multivariable analysis revealed AJCC, Child-Pugh Score, MELD, 73 tumor size, tumor location and treatment type had independent influence on survival (p<0.05). 74 In HCV-positive patients, AJCC, MELD, tumor location, treatment allocation and DAA were 75 significant (p<0.05). In patients receiving DAA therapy, only MELD and SVR12 were predictive 76 of overall survival (p<0.05). Conclusions: DAA therapy and achieving SVR12 is associated 77 with increased overall survival in HCV patients with HCC. 78 5 79

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Liver transplant listing for hepatitis C‐associated cirrhosis and hepatocellular carcinoma has fallen in the United Kingdom since the introduction of direct‐acting antiviral therapy

Cited by 21 publications

References 12 publications

Monitoring liver transplant rates in persons diagnosed with hepatitis C: a data linkage study, England 2008 to 2017

Monitoring liver transplant rates in persons diagnosed with hepatitis C: a data linkage study, England 2008 to 2017

Data linkage to monitor hepatitis C‐associated end‐stage liver disease and hepatocellular carcinoma inpatient stays in England

Impact of Direct Acting Antivirals on Survival in Patients with Chronic Hepatitis C and Hepatocellular Carcinoma

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