Reduction in liver transplant wait-listing in the era of direct-acting antiviral therapy.
Reduction in liver transplant wait-listing in the era of direct-acting antiviral therapy.
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DOI：
10.1002/hep.28923
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发表时间：
2017-03
期刊：
影响因子：
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通讯作者：
Terrault NA
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文献类型：
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作者：
Flemming JA;Kim WR;Brosgart CL;Terrault NA
最近批准的直接作用的抗病毒（DAA）治疗失代偿性肝硬化（DC）继发于丙型肝炎（HCV）的患者与改善肝功能。我们分析了肝移植（LT）等待名单（WL）的趋势，以探讨有效的药物治疗对WL登记的潜在影响。这是一项使用2003-2015年移植受体科学登记数据库的队列研究。确定了47，591名等待接受LT的成人，包括HCV、B型肝炎（HBV）和非酒精性脂肪性肝炎（NASH）。如果WL时终末期肝病（MELD）模型≥ 15或肝细胞癌（HCC），则LT适应症定义为DC。上市时代分为“干扰素”（[IFN] 2003-2010）、“蛋白酶抑制剂”（[PI] 2011-2013）和“直接作用的抗病毒药”（[DAA] 2014-2015）。采用Poisson回归分析WL的年标准化发病率。与干扰素治疗相比，HCV患者中DC的LT WL校正发生率在PI时代下降了5%（P = 0.004），在DAA时代下降了32%（P <0.001）。HBV中DC的列表在PI（-17%，P = 0.002）和DAA时代（-24%，P <.001）也有所下降。相反，NASH中DC的WL在PI时期增加了41%（P <0.001），在DAA时期增加了81%（P <0.001）。在PI和DAA时期，HCV和NASH人群中HCC的WL均增加（所有P <0.001），而HBV人群中HCC的WL保持稳定（所有P > 0.05）。结论：在DAA治疗的时代，HCV合并DC的LT WL率下降了30%以上。随着检测的增加、与护理的联系以及DAA治疗的获得，预计WL将进一步减少。
Recent approval of direct-acting antiviral (DAA) therapy for patients with decompensated cirrhosis (DC) secondary to hepatitis C (HCV) is associated with improved hepatic function. We analyzed trends in liver transplant (LT) wait-listing (WL) to explore potential impact of effective medical therapy on WL registration. This is a cohort study using the Scientific Registry of Transplant Recipients database from 2003-2015. 47,591 adults wait-listed for LT from HCV, hepatitis B (HBV) and non-alcoholic steatohepatitis (NASH) were identified. LT indication was defined as DC if the model for end-stage liver disease (MELD) at WL was ≥ 15 or hepatocellular carcinoma (HCC). Era of listing was divided into “interferon” ([IFN] 2003-2010), “protease inhibitor” ([PI] 2011-2013), and “direct-acting antiviral” ([DAA] 2014-2015). Annual standardized incidence rates of WL were analyzed using Poisson regression. Adjusted incidences of LT WL for DC in HCV patients decreased by 5% in the PI era (P = 0.004) and 32% in the DAA era (P <.001) compared to the IFN era. Listing for DC in HBV also decreased in the PI (−17%, P = 0.002) and DAA eras (−24%, P <.001). Conversely, WL for DC in NASH increased by 41% in the PI era (P <.001) and 81% in the DAA era (P <.001). WL for HCC in both the HCV and NASH populations increased in both PI and DAA eras (P <.001 for all) while HCC WL in HBV remained stable (P > 0.05 for all). Conclusions: The rate of LT WL for HCV complicated by DC has decreased by over 30% in the era of DAA therapy. Further reductions in WL are anticipated with increased testing, linkage to care, and access to DAA therapy.