Trends in liver transplantation for hepatitis C in a country with reduced access to direct-acting antiviral agents

MELISA DIRCHWOLF; SEBASTIÁN MARCIANO ; DIEGO H GIUNTA; MARIA LOURDES POSADAS MARTINEZ; SCOTT W BIGGINS; ANDRÉS E RUF

CLINICAL TRANSPLANTATION

WILEY-BLACKWELL PUBLISHING, INC

Lugar: Londres; Año: 2018

0902-0063

Clin Transplant. 2018 Apr;32(4):e13230. doi: 10.1111/ctr.13230. Epub 2018 Mar 23.Trends in liver transplantation for hepatitis C in a country with reduced access to direct-acting antiviral agents.Dirchwolf M1, Marciano S2,3, Giunta DH3, Posadas-Martínez ML3, Biggins SW4, Ruf AE1,5.Author informationAbstractBACKGROUND:Hepatitis C virus (HCV)-related cirrhosis is a leading indication for liver transplantation (LT) worldwide. Access to effective HCV treatment is inequitable globally. We aimed to analyze whether the introduction of effective HCV treatment caused an impact in LT trends in a middle-income country.METHODS:Cross-sectional analysis of all adult patients who were listed/received a LT in Argentina for HCV, alcohol-related liver disease (ALD), or autoimmune hepatitis/primary biliary cirrhosis (AIH/PBC) from 2007 to 2017. Joinpoint regression analysis was used to identify changes in the cumulative incidence rates in waiting list (WL) registration, WL mortality, and LT.RESULTS:Liver transplantation WL for HCV increased significantly between 2007 and 2014, with an annual percentage change (APC) +7.8%, P = .01, followed by a downward slope from 2014 to 2017 with an APC -9.8%, P = .1. There were no significant changes in WL mortality. LT trends remained stable. LT for HCV without MELD exception points for HCC decreased (APC -6.6%, P = .01), whereas LT for HCV with HCC exception points increased (APC +11.1, P = .01) during the study period.CONCLUSION:Waiting list and LT for HCV without HCC decreased, whereas LT for HCV and HCC increased; this may be related to selective antiviral treatment access for patients with advanced fibrosis.© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.KEYWORDS:direct-acting antivirals; hepatitis C; joinpoint regression analysis; liver transplantation; trends; waiting list analysis