Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Saturday, 10 / 24 / 2020

Articles

ORIGINAL ARTICLE

Changing Population of Liver Transplant Recipients in the Era of Direct-acting Antiviral Therapy

Chencheng Xie1,2, Yong-Fang Kuo3and Ashwani K. Singal2,4,*

1  Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
2  Department of Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
3  Division of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
4  Division of Transplant Hepatology, Avera Transplant Institute, Sioux Falls, SD, USA
*Correspondence to: Ashwani K. Singal, University of South Dakota Sanford School of Medicine, Transplant Hepatologist Avera McKennan University Hospital and Transplant Institute, Chief Clinical Research Affairs Avera Transplant Institute, Sioux Falls, SD 57105, USA. Tel: +1-605-322-8535 (Office), +1-605-322-7350 (Clinic), +1-605-322-5989 (Research), Fax: +1-605-322-8536, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2020;8(3):262-266 DOI: 10.14218/JCTH.2020.00032
Received: April 14, 2020 AcceptedJuly 17, 2020 Published online: August 10, 2020

Abstract

Background and Aims: With the availability of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection and changing liver disease etiology for liver transplantation (LT), data on the changes in LT recipient population in the DAA era are scanty.

Methods: The United Network for Organ Sharing (UNOS) registry (01/2007 to 06/2018) was used to develop a retrospective cohort of LT recipients for HCV, alcohol-associated liver disease (ALD), and non-alcoholic steatohepatitis (NASH). LT recipients in the DAA era (2013-2018) were compared with those in the pre-DAA era (2007-2012) era for recipient characteristics. Chi-square and analysis of variance were the statistical tests used for categorical and continuous variables, respectively.

Results: Of 40,309 LT recipients (21,110 HCV, 7586 NASH, and 11,713 ALD), the 21,790 in the DAA era (9432 HCV, 7240 ALD, and 5118 NASH) were more likely to be older, female, obese, diabetic, have acute-on-chronic liver failure with a higher model for end-stage liver disease score, receive grafts with a lower donor risk index, and have waited on the LT list for a shorter period compared with their pre-DAA era counterparts. Specific to ALD, LT recipients with alcohol hepatitis were more likely to be younger at the time of LT. Of 9895 LT recipients with hepatocellular carcinoma, recipients in the DAA era were observed to have a higher proportion of HCV (43% vs. 32%, p<0.001), a lower proportion of ALD (9% vs. 12%, p<0.001), and no change for NASH (13% vs. 13%, p=0.9) compared with the pre-DAA era. Within the hepatocellular carcinoma population, LT recipients in the DAA era were older, diabetic, and waited on the LT list longer compared with their pre-DAA counterparts.

Conclusions: Along with changing liver disease etiology in the DAA era, the LT recipient population demographics, comorbidities, liver disease severity, and graft quality are changing. These changes are relevant for future studies, immunosuppression, and post-transplant follow-up.

Keywords

DAA, Cirrhosis, OLT

Journal of Clinical and Translational Hepatology 2020 vol. 8, 262-266  [ Html  ] [ PDF Full-text ]

© The Authors 2020. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

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