Improved Graft Survival After Liver Transplantation for Recipients With Hepatitis C Virus in the Direct-Acting Antiviral Era

被引：74

作者：

Cotter, Thomas G. ^{[1
]}

Paul, Sonali ^{[1
]}

Sandikci, Burhaneddin ^{[4
]}

Couri, Thomas ^{[2
]}

Bodzin, Adam S. ^{[3
]}

Little, Ester C. ^{[5
]}

Sundaram, Vinay ^{[6
,7
]}

Charlton, Michael ^{[1
]}

机构：

[1] Univ Chicago Med, Ctr Liver Dis, 5841 South Maryland Ave, Chicago, IL 60637 USA

[2] Univ Chicago Med, Dept Med, Chicago, IL USA

[3] Univ Chicago Med, Dept Surg, Sect Abdominal Organ Transplantat, Chicago, IL USA

[4] Univ Chicago, Booth Sch Business, Chicago, IL 60637 USA

[5] Banner Univ, Med Ctr, Phoenix, AZ USA

[6] Cedars Sinai Med Ctr, Div Gastroenterol, Los Angeles, CA 90048 USA

[7] Cedars Sinai Med Ctr, Comprehens Transplant Ctr, Los Angeles, CA 90048 USA

来源：

LIVER TRANSPLANTATION | 2019年 / 25卷 / 04期

关键词：

GENOTYPE; 1; HCV; INFECTION; PIBRENTASVIR; GLECAPREVIR; BOCEPREVIR; TELAPREVIR; SOFOSBUVIR; LEDIPASVIR; OUTCOMES;

D O I：

10.1002/lt.25424

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Highly effective direct-acting antiviral (DAA) therapy has transformed outcomes of liver transplantation in hepatitis C virus (HCV) patients. We examined longer-term outcomes in HCV-positive recipients in the DAA era and analyzed the Scientific Registry of Transplant Recipients for primary adult, single-organ, nonfulminant liver transplant recipients in the United States from January 1, 2008 to June 30, 2018. Graft loss was compared among I ICV-positive liver transplant recipients who received either an HCV-negative or HCV-positive donor (donor [D]-/recipient [R]+; D+/R+) and HCV-negative liver transplant recipients who received a HCV-negative donor (D-/R-). The groups were further divided between the pre-DAA and DAA eras. There were 52,526 patients included: 31,193 were D-/R- patients; 18,746 were D-/R+ patients; and 2587 were D+/R+ patients. The number of D-/R+ transplants decreased from 2010 in 2008 to 1334 in 2017, with this decline particularly noticeable since 2015. D-/R+ patients in the DAA era (n = 7107) were older, had higher rates of hepatocellular carcinoma, and lower Model for End-Stage Liver Disease scores than those in the pre-DAA era. Graft survival improved for all recipients in the DAA era but improved most dramatically in HCV-positive recipients: D-/R+ 1-year survival was 92.4% versus 88.7% and 3-year survival was 83.7% versus 77.7% (DAA versus pre-DAA era, respectively) compared with D-/R- 1-year survival of 92.7% versus 91.0% and 3-year survival of 85.7% versus 84.0% (DAA versus pre-DAA era, respectively). The magnitude of improvement in 3-year graft survival was almost 4-fold greater for D-/R+ patients. The 3-year survival for D+/R+ patients was similar to HCV-negative patients. In conclusion, the number of liver transplants for HCV has decreased by more than one-third over the past decade. Graft survival among HCV-positive recipients has increased disproportionately in the DAA era with HCV-positive recipients now achieving similar outcomes to non-HCV recipients.

引用

页码：598 / 609

页数：12

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