Reduction in liver transplant wait‐listing in the era of direct‐acting antiviral therapy

• DOI: 10.1002/hep.28923
• Publication Date: 2016-11-05T14:49:53Z
• Authors: Jennifer A. Flemming; W. Ray Kim; Carol L. Brosgart; Norah A. Terrault
• Keywords: Listing (finance); Antiviral Therapy

Direct‐acting antiviral (DAA) therapy, recently approved for patients with decompensated cirrhosis (DC) secondary to hepatitis C virus (HCV), is associated improved hepatic function. We analyzed trends in liver transplant (LT) wait‐listing (WL) explore potential impact of effective medical therapy on WL registration. This a cohort study using the Scientific Registry Transplant Recipients database from 2003 2015. A total 47,591 adults wait‐listed LT HCV, B (HBV), and nonalcoholic steatohepatitis (NASH) were identified. indication was defined as DC if Model End‐Stage Liver Disease (MELD) at ≥15 or hepatocellular carcinoma (HCC). Era listing divided into interferon (IFN; 2003‐2010), protease inhibitor (PI; 2011‐2013), direct‐acting (DAA; 2014‐2015). Annual standardized incidence rates Poisson regression. Adjusted incidences HCV decreased by 5% PI era ( P = 0.004) 32% DAA < 0.001) compared IFN era. Listing HBV also (–17%; 0.002) eras (–24%; 0.001). Conversely, NASH increased 41% 81% HCC both populations 0.001 all) whereas remained stable > 0.05 all). Conclusion : The rate complicated has over 30% therapy. Further reductions are anticipated testing, linkage care, access (H epatology 2017;65:804‐812).