Reduction in liver transplant wait‐listing in the era of direct‐acting antiviral therapy

Abstract

Recent approval of direct-acting antiviral (DAA) therapy for patients with decompensated cirrhosis (DC) secondary to hepatitis C (HCV) is associated with improved hepatic function. We analyzed trends in liver transplant (LT) wait-listing (WL) to explore potential impact of effective medical therapy on WL registration. This is a cohort study using the Scientific Registry of Transplant Recipients database from 2003-2015. 47,591 adults wait-listed for LT from HCV, hepatitis B (HBV) and non-alcoholic steatohepatitis (NASH) were identified. LT indication was defined as DC if the model for end-stage liver disease (MELD) at WL was ≥ 15 or hepatocellular carcinoma (HCC). Era of listing was divided into “interferon” ([IFN] 2003-2010), “protease inhibitor” ([PI] 2011-2013), and “direct-acting antiviral” ([DAA] 2014-2015). Annual standardized incidence rates of WL were analyzed using Poisson regression. Adjusted incidences of LT WL for DC in HCV patients decreased by 5% in the PI era (P = 0.004) and 32% in the DAA era (P <.001) compared to the IFN era. Listing for DC in HBV also decreased in the PI (−17%, P = 0.002) and DAA eras (−24%, P <.001). Conversely, WL for DC in NASH increased by 41% in the PI era (P <.001) and 81% in the DAA era (P <.001). WL for HCC in both the HCV and NASH populations increased in both PI and DAA eras (P <.001 for all) while HCC WL in HBV remained stable (P > 0.05 for all). Conclusions: The rate of LT WL for HCV complicated by DC has decreased by over 30% in the era of DAA therapy. Further reductions in WL are anticipated with increased testing, linkage to care, and access to DAA therapy.

Improved liver transplant waitlist mortality and lower risk of disease progression among chronic hepatitis C patients awaiting liver transplantation after the introduction of direct‐acting antiviral therapies in the United States

“…The decrease in HCV‐related listings is likely a reflection of the effectiveness of the latest generation of DAAs and has been shown in other population studies. Flemming et al reported a 30% decrease in the rate of HCV‐related listings with the advent of the latest DAAs, and a 34% rate increase in HCV‐HCC listings. While Van der Meer et al showed that patients who achieved SVR with interferon had a significantly lower cumulative HCC occurrence (5.1%; 95% CI: 1.3%‐8.9%) compared to patients who did not achieve SVR (29.9%; 95%CI: 24.3%‐35.5%), the improvements in hepatic dysfunction and fibrosis progression may outpace the decreased risk of HCC associated with SVR .…”

The benefits of hepatitis C virus cure: Every rose has thorns

“…Annual standardized incidence rates of wait‐listing were compared depending on the indication for transplantation (HCV, HBV or NASH). While the number of patients on the waiting list for NASH increased and the number listed for HBV remained fairly stable, the number of patients listed for decompensated cirrhosis secondary to HCV fell by 32% in the era of DAA therapy as compared to the IFN era and is now equal to that of NASH …”

Alcoholic Liver Disease Replaces Hepatitis C Virus Infection as the Leading Indication for Liver Transplantation in the United States

“…1 Furthermore, data through 2015 demonstrated a decline in the number of HCV-related LT waitlist registrations and LT surgeries following the introduction of DAA-based regimens. 2,3 Despite the downtrend, primary diagnosis of HCV remained the most common cause for liver transplantation in the United States until the end of 2015. 3 In this updated report, we evaluated the current impact of DAA era on the rate of HCV-related liver transplantation in the United States.…”

“…2,3 Despite the downtrend, primary diagnosis of HCV remained the most common cause for liver transplantation in the United States until the end of 2015. 3 In this updated report, we evaluated the current impact of DAA era on the rate of HCV-related liver transplantation in the United States.…”