Department of Medicine, Division of Gastroenterology and Hepatology, University of Iowa Hospital & Clinics, Iowa City, IA, USA.
Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Transpl Int. 2019 Aug;32(8):854-864. doi: 10.1111/tri.13424. Epub 2019 Mar 26.
Benefit of direct-acting antivirals (DAA) for hepatitis C virus (HCV) on clinical outcomes is unclear. We examined temporal trends in liver transplant (LT) listings, receipt of LT, re-LT, and survival between pre-DAA (2009-2012) and DAA era (2013-2016) using UNOS database. Of 32 319 first adult LT, 15 049 (47%) were performed for HCV. Trends on listing, first LT, and of re-LT for HCV showed 23%, 20%, and 21% decrease in DAA compared to pre-DAA era (P < 0.0001). One-year liver graft and patient survival among HCV LT improved in DAA era (90% vs. 86% and 92% vs. 88%, respectively, P < 0.0001). Non-HCV LT showed no improvement in survival (89% vs. 89% and 92% vs. 92.4%, P = NS). On cox regression, compared to non-HCV LTs in DAA era, LT for HCV in pre-DAA era had worse patient survival (HR 1.56 [1.04-2.35]). The outcome was similar when compared to LTs for HCV in DAA era and for non-HCV in pre-DAA era. Burden of HCV-related LT waitlist and LT is declining in DAA era, with improved post-transplant outcomes, more so in later than earlier DAA era. Our findings negate recent Cochrane meta-analysis on DAA therapy and encourage studies to examine HCV clinical outcomes outside LT setting.
直接作用抗病毒药物（DAA）对丙型肝炎病毒（HCV）的临床疗效尚不清楚。我们使用 UNOS 数据库，研究了 DAA 时代（2013-2016 年）与 DAA 前时代（2009-2012 年）之间肝移植（LT）名单、LT 接受、再 LT 和生存的时间趋势。在 32319 例首次成人 LT 中，有 15049 例（47%）是 HCV 引起的。与 DAA 前时代相比，DAA 时代 HCV 的名单、首次 LT 和再 LT 呈 23%、20%和 21%的下降趋势（P<0.0001）。DAA 时代 HCV LT 的 1 年肝移植物和患者生存率提高（分别为 90%比 86%和 92%比 88%，P<0.0001）。非 HCV LT 的生存率无改善（分别为 89%比 89%和 92%比 92.4%，P=NS）。在 Cox 回归中，与 DAA 时代的非 HCV LT 相比，DAA 前时代的 HCV LT 患者生存率较差（HR 1.56 [1.04-2.35]）。与 DAA 时代的 HCV LT 和 DAA 前时代的非 HCV LT 相比，结果相似。在 DAA 时代，HCV 相关 LT 候补名单和 LT 的负担正在下降，移植后结局改善，DAA 时代晚期比早期更为明显。我们的研究结果否定了最近关于 DAA 治疗的 Cochrane 荟萃分析，并鼓励研究在 LT 之外检查 HCV 的临床结局。
