Liver transplantation for chronic hepatitis C virus infection in the United States 2002–2014: An analysis of the UNOS/OPTN registry

• DOI: 10.1371/journal.pone.0186898
• Publication Date: 2017-10-31T18:13:12Z
• Authors: Georg Dultz; Barry I. Graubard; Paul Martin; Martin-Walter Welker; Johannes Vermehren; Stefan Zeuzem; Katherine A. McGlynn; Tania M. Welzel
• Keywords: Male; Tissue and Organ Procurement; Waiting Lists; Science; 610; 03 medical and health sciences; 0302 clinical medicine; Outcome Assessment, Health Care; Humans; ddc:610; Registries; Aged; Proportional Hazards Models; ddc:610; Q; R; Hepatitis C, Chronic; Middle Aged; Survival Analysis; United States; Liver Transplantation; 3. Good health; Survival Rate; Logistic Models; Medicine; Female; Research Article

Chronic hepatitis C virus (HCV) infection is a leading cause for orthotopic liver transplantation (OLT) in the U.S. We investigated characteristics of HCV-infected patients registered for OLT, and explored factors associated with mortality. Data were obtained from the United Network for Organ Sharing and Organ Procurement and Transplantation network (UNOS/OPTN) registry. Analyses included 41,157 HCV-mono-infected patients ≥18 years of age listed for cadaveric OLT between February 2002 and June 2014. Characteristics associated with pre- and post-transplant survival and time trends over the study period were determined by logistic and Cox proportional hazard regression analyses and Poisson regressions. Most patients were white (69.1%) and male (70.8%). At waitlist registration, mean age was 54.6 years and mean MELD was 16. HCC was recorded in 26.9% of the records. A total of 51.2% of the patients received an OLT, 21.0% died or were too sick; 15.6% were delisted and 10.4% were still waiting. Factors associated with increased waitlist mortality were older age, female gender, blood type 0, diabetes, no HCC and transplant region (p<0.001). OLT recipient characteristics associated with increased risk for post OLT mortality were female gender, age, diabetes, race (p<0,0001), and allocation MELD (p = 0.005). Donor characteristics associated with waitlist mortality included age, ethnicity (p<0.0001) and diabetes (p<0.03). Waitlist registrations and OLTs for HCC significantly increased from 14.4% to 37.3% and 27.8% to 38.5%, respectively (p<0.0001). Pre- and post-transplant survival depended on a variety of patient-, donor-, and allocation- characteristics of which most remain relevant in the DAA-era. Still, intensified HCV screening strategies and timely and effective treatment of HCV are highly relevant to reduce the burden of HCV-related OLTs in the U.S.