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Am J Transplant. 2018 Oct;18(10):2473-2482. doi: 10.1111/ajt.14895. Epub 2018 May 29.

The impact of direct-acting antiviral agents on liver and kidney transplant costs and outcomes.

Author information

1
Lahey Hospital & Medical Center, Burlington, MA, USA.
2
Saint Louis University Center for Abdominal Transplantation, St. Louis, MO, USA.
3
Washington University, St. Louis, MO, USA.
4
University of Pennsylvania, Philadelphia, PA, USA.
5
Symphony Health, Conshohocken, PA, USA.
6
Johns Hopkins University, Baltimore, MD, USA.
7
University of Michigan, Ann Arbor, MI, USA.
8
University of Alberta, Edmonton, AB, Canada.
9
Hennepin County Medical Center, Minneapolis, MN, USA.

Abstract

Direct-acting antiviral medications (DAAs) have revolutionized care for hepatitis C positive (HCV+) liver (LT) and kidney (KT) transplant recipients. Scientific Registry of Transplant Recipients registry data were integrated with national pharmaceutical claims (2007-2016) to identify HCV treatments before January 2014 (pre-DAA) and after (post-DAA), stratified by donor (D) and recipient (R) serostatus and payer. Pre-DAA, 18% of HCV+ LT recipients were treated within 3 years and without differences by donor serostatus or payer. Post-DAA, only 6% of D-/R+ recipients, 19.8% of D+/R+ recipients with public insurance, and 11.3% with private insurance were treated within 3 years (P < .0001). LT recipients treated for HCV pre-DAA experienced higher rates of graft loss (adjusted hazard ratio [aHR] 1.34 1.852.10 , P < .0001) and death (aHR 1.47 1.681.91 , P < .0001). Post-DAA, HCV treatment was not associated with death (aHR 0.34 0.671.32 , P = .25) or graft failure (aHR 0.32 0.641.26 , P = .20) in D+R+ LT recipients. Treatment increased in D+R+ KT recipients (5.5% pre-DAA vs 12.9% post-DAA), but did not differ by payer status. DAAs reduced the risk of death after D+/R+ KT by 57% (0.19 0.430.95 , P = .04) and graft loss by 46% (0.27 0.541.07 , P = .08). HCV treatment with DAAs appears to improve HCV+ LT and KT outcomes; however, access to these medications appears limited in both LT and KT recipients.

KEYWORDS:

clinical research/practice; economics; health services and outcomes research; infection and infectious agents - viral: hepatitis C; kidney (allograft) function/dysfunction; kidney transplantation/nephrology; liver allograft function/dysfunction; liver transplantation/hepatology; patient survival

PMID:
29701909
PMCID:
PMC6409105
[Available on 2019-10-01]
DOI:
10.1111/ajt.14895

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