1 Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL, USA.
2 Booth School of Business, University of Chicago, Chicago, IL, USA.
3 Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA.
4 Department of Surgery, Section of Abdominal Organ Transplantation, The University of Chicago Medicine, Chicago, IL, USA.
5 Banner University Medical Center, Phoenix, AZ, USA.
6 Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
BACKGROUND: Highly effective direct acting antiviral (DAA) therapy has transformed outcomes of liver transplantation in HCV patients. We examined longer-term outcomes in HCV-positive recipients in the DAA era.
METHODS: We analyzed the Scientific Registry of Transplant Recipients (SRTR) for primary adult, single organ, non-fulminant liver transplant recipients in the US from January 1, 2008, to June 30, 2018. Graft loss was compared among HCV-positive liver transplant recipients that received an HCV-negative and -positive donors (D-/R+) (D+/R+) and HCV-negative liver transplant recipients that received an HCV-negative donor (D-/R-). The groups were further divided between the pre- and DAA eras.
RESULTS: 52,526 patients were included; 31,193 D-/R-, 18,746 D-/R+ and 2,587 D+/R+. The number of D-/R+ transplants decreased from 2,010 in 2008 to 1,334 in 2017, with this decline particularly noticeable since 2015. D-/R+ patients in the DAA era (n=7,107) were older, had higher rates of hepatocellular carcinoma, and lower MELD scores than those in the pre-DAA era. Graft survival improved for all recipients in the DAA era but most dramatically in HCV-positive recipients: D-/R+ 1-year survival was 92.4% vs 88.7% and 3-year survival was 83.7% vs 77.7% (DAA vs. pre-DAA era, respectively), compared to D-/R- 1-year survival of 92.7% vs 91.0% and 3-year survival of 85.7% vs 84.0% (DAA vs. pre-DAA era, respectively). The magnitude of improvement in 3-year graft survival was almost 4-fold greater for D-/R+. The 3-year survival for D+/R+ patients was similar to HCV-negative patients.
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.