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

Abstract

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.

The impact of direct‐acting antivirals on hepatitis C viraemia among people who inject drugs in England; real‐world data 2011–2018

“…Our finding of a reduction in HCV viraemia is corroborated by NHS Blood and Transplant Service data showing the number of liver transplant registrations and operations undertaken for HCV‐associated cirrhosis and hepatocellular carcinoma fell by 44% and 29% in 2018, respectively, when compared to pre‐2015 levels, 5 and this is evidence of early impact of DAAs on transplants was also observed in a data linkage study of HCV diagnosed individuals. 31 There has also been a 20% fall in HCV‐related deaths in England between 2015 and 2018, exceeding the WHO target 3 years early and twofold. 6 , 32 However, these are only early signs of improvement, and there is evidence to suggest the number of new infections may have risen in 2018.…”