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Abstract Details
Turning the tide on hepatitis C-related liver transplantation: the return on investment in hepatitis C treatment in Australia and New Zealand
Liver Transpl. 2021 Oct 8. doi: 10.1002/lt.26329. Online ahead of print.
Jess Howell1234, Avik Majumdar56, Michael Fink78, Mandy Byrne7, Geoff McCaughan56, Simone I Strasser56, Michael Crawford56, Peter Hodgkinson9, Katherine A Stuart9, Caroline Tallis9, John Chen10, Alan Wigg10, Robert Jones78, Bryon Jaques11, Gary Jeffrey1112, Leon Adams1112, Michael C Wallace1112, Stephen Munn13, Ed Gane1314, Alex Thompson12, Paul Gow17
Author information
1Department of Medicine, University of Melbourne, Melbourne, Australia.
2Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Australia.
3Disease Elimination Department, Burnet Institute, Melbourne, Australia.
4Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
5Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney Australia.
6AW Morrow GE and Liver Centre, University of Sydney, Sydney, Australia.
7Victorian Liver Transplant Unit, Austin Health, Melbourne Australia.
8Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Australia.
9Queensland Liver Transplant Service, Princess Alexandra Hospital and Queensland Children's Hospital, Brisbane, Australia.
10South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, Australia.
11WA Liver Transplant Service, Sir Charles Gairdner Hospital, Perth, Australia.
12Medical School, University of Western Australia, Perth, Australia.
13New Zealand Liver Transplant Service, Auckland City Hospital and Starship Children's Hospital, Auckland New Zealand.
14Department of Medicine, University of Auckland, Auckland New Zealand.
Abstract
Background: Introduction of universal access to direct-acting antiviral therapy (DAAs) for hepatitis C (HCV) in Australia and New Zealand on March 31st 2016 has had a major impact on the number of people with chronic HCV infection, but the impact on liver transplantation rates is unknown.
Methods: We conducted a retrospective registry study including all adult liver transplants from the Australian and New Zealand Liver and Intestinal Liver Transplant Registry dataset (ANZLITR). Interrupted time series analysis determined the impact of DAAs in 2016 on the number of HCV liver transplants per year. Cox regression analysis was used to determine the impact of DAAs on post liver transplant survival.
Results: Between 1st January 1990 and 31st December 2019, 5318 adult liver transplants were performed, 29% (1531) were for hepatitis C infection. Prior to introduction of DAAs, there was a mean increase of 3.5 adult liver transplants performed for HCV per annum, but between 2016 to 2019 there was a mean decrease of 7.9 adult liver transplants per annum (p<0.0001). Similarly, the proportion of liver transplants performed for HCV increased from 9% (1990) to 33% in 2016, then fell to 23% in 2019 (p<0.001). The number and proportion of patients with hepatitis C waitlisted for liver transplantation also fell from 2016 (p<0.001) comparative to other indications. Introduction of DAAs was associated with a 31% reduction in death after liver transplantation, adjusted for age at transplant and hepatocellular carcinoma (HR 0.69, 95% CI 0.48-0.99, p=0.047).
Conclusion: The number of adult liver transplants performed for HCV-related liver cirrhosis and HCC has reduced since introduction of universal access to DAAs in 2016 in Australia and New Zealand.