Wait-listing for liver transplantation decreasing in the DAA era

BOSTON — Wait-listing for liver transplantation among decompensated cirrhotics decreased by approximately 30% between the interferon and direct-acting antiviral eras, according to findings presented at The Liver Meeting 2016.

“The main take home point from this abstract is that we are now moving from seeing the impact of DAA therapy from an individual patient level to a national population-based level,” Jennifer A. Flemming, MD, of the departments of Medicine and Public Health Services at Queens University in Kingston, Ontario, told Healio.com/Hepatology in an interview.

Flemming and colleagues, assessed trends in liver transplantation wait-listing to determine whether successful HCV therapy impacted registration for transplantation. The cohort study included data from the Scientific Registry of Transplant Recipients database between 2003 and 2015. Findings for 47,591 adults wait-listed for liver transplantation due to HCV, hepatitis B virus and NASH underwent analysis.

Patients with a MELD score at 15 or greater and those with hepatocellular carcinoma were defined as those with decompensated cirrhosis. Further stratifications were included for the interferon era (2003-2010), the protease inhibitor era (2011-2013) and the DAA era (2014-2015). The researchers computed annual standardized incidence rates of wait-listing.

Results indicated that adjusted incidence rates of liver transplantation wait-listing among decompensated cirrhotics decreased by 5% from the IFN era to the protease inhibitor era (P = .004), and by 32% from the IFN era to the DAA era (P < .001). A decrease in wait-listing for decompensated cirrhotics with HBV also decreased from the IFN era to the PI era (–17%; P = .002) and to the DAA era (–24%; P < .001).

However, wait-listing for decompensated cirrhotics with NASH increased by 41% from the IFN era to the protease inhibitor era (P < .001) and by 81% from IFN to DAA (P < .001).

Findings from 2015 showed that the adjusted incidence rates of wait-listing for liver transplantation for decompensated cirrhosis were similar in NASH and HCV, 2.80 per 100,000 vs. 2.73 per 100,000.

Wait-listing for HCC among patients with both HCV and NASH increased during the protease inhibitor and DAA eras (P < .001 for all). Wait-listing in HBV-associated HCC remained stable through the eras (P > .005 for all).

The rate of wait-listing for HCV-associated decompensated cirrhosis has decreased by over 30% in the DAA era, the researchers concluded. Thy added that the rate is comparable to that of NASH, and that more reductions in wait-listing may be forthcoming.

“As clinicians, we have all seen the impact of DAA therapy on individual patients with respect to improvements in liver function in those with decompensated disease,” Flemming said. “Our data suggests that even in the first 2 years of access to DAA therapy, there is evidence that it is already having a dramatic effect with respect to the national liver transplant wait list. We hypothesize that these trends will continue into the next decade as more patients with hepatitis C are identified through screening and receive linkage to HCV care.”

Reference:

Flemming JA, et al. Abstract LB-23. Presented at: The Liver Meeting; Nov. 11-15, 2016; Boston.

Disclosures: Flemming reports no relevant financial disclosures.