Optimal Timing of Hepatitis C Treatment for Patients on the Liver Transplant Waiting List
Optimal Timing of Hepatitis C Treatment for Patients on the Liver Transplant Waiting List
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DOI：
10.1002/hep.28926
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发表时间：
2017-03-01
期刊：
影响因子：
13.5
通讯作者：
Chung, Raymond T.
中科院分区：
文献类型：
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作者：
Chhatwal, Jagpreet;Samur, Sumeyye;Chung, Raymond T.
口服直接作用抗病毒药物的可用性已经改变了丙型肝炎病毒（HCV）治疗模式，无论是肝移植前（LT）患者还是肝移植后患者。肝移植前治疗与肝移植后治疗之间存在明显的权衡——肝移植治疗可能改善肝功能，但可能降低必要肝移植的可能性。我们的目标是根据终末期肝病模型（MELD）评分，确定符合肝移植条件的失代偿性肝硬化患者，他们将从肝移植前治疗中受益（或不受益）。我们模拟了一项虚拟试验，比较了MELD评分在10到40之间的患者在肝移植前和肝移植后使用口服直接抗病毒药物治疗HCV的长期结果。我们开发了一个基于markov的微观模拟模型，模拟移植等待名单上和移植后患者的生命过程。移植模拟综合了近期口服直接作用抗病毒药物（SOLAR 1和2）、器官共享联合网络（UNOS）和其他研究的数据。该模型的结果包括预期寿命、1年和5年患者生存率和死亡率。用UNOS数据验证了模型预测的患者生存。我们发现，在国家层面上，如果MELD是，在肝移植前治疗HCV可以增加预期寿命
The availability of oral direct-acting antivirals has altered the hepatitis C virus (HCV) treatment paradigm for both preliver transplant (LT) and post-LT patients. There is a perceived trade-off between pre-LT versus post-LT treatment of HCV-treatment may improve liver function but potentially decrease the likelihood of a necessary LT. Our objective was to identify LT-eligible patients with decompensated cirrhosis who would benefit (and not benefit) from pre-LT treatment based on their Model for End-Stage Liver Disease (MELD) scores. We simulated a virtual trial comparing long-term outcomes of pre-LT versus post-LT HCV treatment with oral direct-acting antivirals for patients with MELD scores between 10 and 40. We developed a Markov-based microsimulation model, which simulated the life course of patients on the transplant waiting list and after LT. Simulation of LT integrated data from recent trials of oral direct-acting antivirals (SOLAR 1 and 2), the United Network for Organ Sharing (UNOS), and other studies. The outcomes of the model included life expectancy, 1-year and 5-year patient survival, and mortality. Model-predicted patient survival was validated with UNOS data. We found that, at the national level, treating HCV before LT increased life expectancy if MELD was