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Comparative Study
. 2017 Mar;65(3):804-812.
doi: 10.1002/hep.28923. Epub 2016 Dec 24.

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

Jennifer A Flemming  1 , W Ray Kim  2 , Carol L Brosgart  3 , Norah A Terrault  3
Affiliations
Comparative Study

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

Jennifer A Flemming et al. Hepatology. 2017 Mar.

Abstract

Direct-acting antiviral (DAA) therapy, recently approved for patients with decompensated cirrhosis (DC) secondary to hepatitis C virus (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 to 2015. A total of 47,591 adults wait-listed for LT from HCV, hepatitis B virus (HBV), and nonalcoholic 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 < 0.001) compared to the IFN era. Listing for DC in HBV also decreased in the PI (-17%; P = 0.002) and DAA eras (-24%; P < 0.001). Conversely, WL for DC in NASH increased by 41% in the PI era (P < 0.001) and 81% in the DAA era (P < 0.001). WL for HCC in both the HCV and NASH populations increased in both the PI and DAA eras (P < 0.001 for all) whereas HCC WL in HBV remained stable (P > 0.05 for all).

Conclusion: 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. (Hepatology 2017;65:804-812).

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Figures

Figure 1
Figure 1
Development of the study cohort. SRTR: scientific registry of transplant recipients; LT: liver transplant; MELD: model for end stage liver disease; HCC: hepatocellular carcinoma; HCV: hepatitis C; HBV: hepatitis B; NASH: non-alcoholic steatohepatitis.
Figure 2
Figure 2
Annual standardized incidence rates (ASIR) of LT wait-listing per 100,000 US population by etiology of liver disease and indication for wait-listing. X-axis is the year of LT wait-listing registration. PI: protease inhibitor; DAA: direct acting antiviral
Figure 3
Figure 3
Annual standardized incidence rates (ASIR) of LT wait-listing per 100,000 US population by etiology of liver disease and indication for wait-listing. X-axis is the year of LT wait-listing registration. PI: protease inhibitor; DAA: direct acting antiviral
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