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. 2017 Oct 31;12(10):e0186898.
doi: 10.1371/journal.pone.0186898. eCollection 2017.

Liver transplantation for chronic hepatitis C virus infection in the United States 2002-2014: An analysis of the UNOS/OPTN registry

Georg Dultz  1 , Barry I Graubard  2 , Paul Martin  3 , Martin-Walter Welker  1 , Johannes Vermehren  1 , Stefan Zeuzem  1 , Katherine A McGlynn  4 , Tania M Welzel  1
Affiliations

Liver transplantation for chronic hepatitis C virus infection in the United States 2002-2014: An analysis of the UNOS/OPTN registry

Georg Dultz et al. PLoS One. .

Abstract

Chronic hepatitis C virus (HCV) infection is a leading cause for orthotopic liver transplantation (OLT) in the U.S. We investigated characteristics of HCV-infected patients registered for OLT, and explored factors associated with mortality. Data were obtained from the United Network for Organ Sharing and Organ Procurement and Transplantation network (UNOS/OPTN) registry. Analyses included 41,157 HCV-mono-infected patients ≥18 years of age listed for cadaveric OLT between February 2002 and June 2014. Characteristics associated with pre- and post-transplant survival and time trends over the study period were determined by logistic and Cox proportional hazard regression analyses and Poisson regressions. Most patients were white (69.1%) and male (70.8%). At waitlist registration, mean age was 54.6 years and mean MELD was 16. HCC was recorded in 26.9% of the records. A total of 51.2% of the patients received an OLT, 21.0% died or were too sick; 15.6% were delisted and 10.4% were still waiting. Factors associated with increased waitlist mortality were older age, female gender, blood type 0, diabetes, no HCC and transplant region (p<0.001). OLT recipient characteristics associated with increased risk for post OLT mortality were female gender, age, diabetes, race (p<0,0001), and allocation MELD (p = 0.005). Donor characteristics associated with waitlist mortality included age, ethnicity (p<0.0001) and diabetes (p<0.03). Waitlist registrations and OLTs for HCC significantly increased from 14.4% to 37.3% and 27.8% to 38.5%, respectively (p<0.0001). Pre- and post-transplant survival depended on a variety of patient-, donor-, and allocation- characteristics of which most remain relevant in the DAA-era. Still, intensified HCV screening strategies and timely and effective treatment of HCV are highly relevant to reduce the burden of HCV-related OLTs in the U.S.

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Conflict of interest statement

Competing Interests: GD, BIG, MWW, KAM: None. PM: Consultancies/speaker Abbvie, Merck. JV: Consultancies/speaker for Abbott, AbbVie, Bristol-Myers Squibb, Gilead, Medtronic, Merck/MSD, Roche. SZ: Consultancies/speaker for Abbvie, BMS, Gilead, Intercept, Janssen, Merck/MSD. TMW: Consultancies/speaker for Abbvie, Bristol-Myers Squibb, Gilead, Janssen. The stated competing interests do not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Patient disposition of hepatitis C infetected patients registered for liver transplantation between 27/FEB/2002 and 30/JUN/2014.
Over half of the waitlist registrants received a liver transplantation while 20% where too sick to transplant or died on the waitlist.
Fig 2
Fig 2. Proportion of baby boomers in the cohort of waitlist registrations overall and in the subgroup with HCC.
An increasing number of registrations with HCV and HCV-related HCC belonged to the baby boomer cohort.
See this image and copyright information in PMC

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