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Liver transplant waits shorter with DAAs



The rate of wait-listing for liver transplants for patients with hepatitis C and decompensated cirrhosis has decreased by over 30% since the entry of direct-acting antiviral (DAA) therapy and now equals the wait-list rate for nonalcoholic steatohepatitis, according to an abstract of a study that will be presented at the annual meeting of the American Association for the Study of Liver Diseases.

Using the U.S. Scientific Registry of Transplant Recipients (SRTR), Jennifer Flemming, MD, and her coauthors developed a cohort of 47,591 adults who were wait-listed for liver transplant because of HCV or hepatitis B virus infection (HBV), or for nonalcoholic steatohepatitis (NASH).

Dr. Flemming, professor of gastroenterology at Queens University, Kingston, Ont., examined trends in liver transplant wait-listing between 2003 and 2015. The time period was divided into the “interferon era,” from 2003 to 2010, the “protease inhibitor era,” from 2011 to 2013, and the “DAA era,” from 2014 to 2015.

Patients were considered to have a transplant indication of decompensated cirrhosis if they had a model for end-stage liver disease (MELD) score of 15 or higher; hepatocellular carcinoma was the other identified transplant indication.

Examining annual standardized incidence rates of wait-listing, Dr. Flemming and her collaborators found that wait-listing for HCV patients with decompensated cirrhosis dropped by 5% during the protease inhibitor era, and by 32% in the DAA era (P = .004 and P less than .001, respectively).

Wait-listing for HBV also dropped, by 17% in the protease inhibitor era and by 24% in the DAA era (P = .002 and P less than .001, respectively). For NASH patients, conversely, wait-listing increased by 41% in the protease inhibitor era, and by 81% in the DAA era (P less than .001 for both). Hepatocellular carcinoma rates also rose during the protease inhibitor and DAA eras.

“Further reductions in [wait-listing] are anticipated with increased testing, linkage to care, and access to DAA therapy,” Dr. Flemming and her coauthors wrote in their study abstract.

Dr. Flemming reported no relevant financial disclosures. Several coauthors reported financial ties to pharmaceutical companies that market DAAs.

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