Long Term Outcomes of Liver Transplantation in the Direct-Acting Antiviral Era of Hepatitis C
There are no reports of long term outcomes of Hepatitis C (HCV) liver transplant (LTx) recipients in the direct-acting antiviral (DAA) era. We aimed to examine impact of DAA’s on survival, examine the populations at risk, cure rates, and long term outcomes.
To our knowledge, this is the first long term outcomes report from a liver transplant center in Florida and the first one to be performed in organ transplantation at Tampa General Hospital. It is certainly the first time that the liver transplant program has analyzed the outcome of all consecutive patients, long term.
We hypothesized that survival of Hepatitis C patients has improved over the last decade, last eras of transplantation, and since creation of specialized Hepatitis C Clinic and availability of direct-acting antiviral (DAA) agents.
Retrospective analysis of 469 HCV LTx, between Dec 1996 and July 25, 2015 (from 1,368 LTx). These were divided in 4 eras: 1 (’97-2001), 2 (2002-06), 3 (2007-10), and Era 4 (2011-15, corresponding to DAA’s). All DAA treatments in this study were post LTx. Kaplan Meier methodology, Log Rank and Chi square were utilized.
Cohorts were selected according to defined time periods or major programmatic changes, personnel, or specialized programs. Additional hypothesis were formulated while examining the impact of the DAA era. We examined which populations had the opportunity to receive DAA’s and hypothesized further that older eras had little benefit from DAA’s. We also examined cure and treatment rates for each era.
The lower 8% mortality in Era 3 prior to 2011 allowed patients the access to highly curative DAA therapies.
Era 4 more than doubled the number of patients treated with DAA’s over Era 3. Era’s 3 and 4 more than tripled the number of patients treated.
Over 90% of the patients in Eras 3 and 4 were alive and available for treatment.
DAA’s had a significant impact on HCV patients in our program while patients in Era 1 and 2 succumbed from hepatitis C complications.
From 2007 forward, progress in HCV outcomes was noted, contributed by DAA and HCV cures. Those transplanted more than 10 years ago were highly excluded from the DAA era. Our three year results suggest that HCV patients now outperform most other populations of transplant patients.