Transplanting hepatitis C virus-positive livers into hepatitis C virus-negative patients with preemptive antiviral treatment: A modeling study.

Autor: Chhatwal J; Massachusetts General Hospital Institute for Technology Assessment, Boston, MA.; Harvard Medical School, Boston, MA.; Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA., Samur S; Massachusetts General Hospital Institute for Technology Assessment, Boston, MA.; Harvard Medical School, Boston, MA., Bethea ED; Massachusetts General Hospital Institute for Technology Assessment, Boston, MA.; Harvard Medical School, Boston, MA.; Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA., Ayer T; Department of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA., Kanwal F; Department of Medicine, Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX.; Houston Veterans Affairs Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX., Hur C; Massachusetts General Hospital Institute for Technology Assessment, Boston, MA.; Harvard Medical School, Boston, MA.; Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA., Roberts MS; Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.; University of Pittsburgh School of Medicine, Pittsburgh, PA., Terrault N; University of California San Francisco Medical Center, San Francisco, CA., Chung RT; Harvard Medical School, Boston, MA.; Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA.
Jazyk: angličtina
Zdroj: Hepatology (Baltimore, Md.) [Hepatology] 2018 Jun; Vol. 67 (6), pp. 2085-2095. Date of Electronic Publication: 2018 Apr 19.
DOI: 10.1002/hep.29723
Abstrakt: Under current guidelines, hepatitis C virus (HCV)-positive livers are not transplanted into HCV-negative recipients because of adverse posttransplant outcomes associated with allograft HCV infection. However, HCV can now be cured post-LT (liver transplant) using direct-acting antivirals (DAAs) with >90% success; therefore, HCV-negative patients on the LT waiting list may benefit from accepting HCV-positive organs with preemptive treatment. Our objective was to evaluate whether and in which HCV-negative patients the potential benefit of accepting an HCV-positive (i.e., viremic) organ outweighed the risks associated with HCV allograft infection. We developed a Markov-based mathematical model that simulated a virtual trial of HCV-negative patients on the LT waiting list to compare long-term outcomes in patients: (1) willing to accept any (HCV-negative or HCV-positive) liver versus (2) those willing to accept only HCV-negative livers. Patients receiving HCV-positive livers were treated preemptively with 12 weeks of DAA therapy and had a higher risk of graft failure than those receiving HCV-negative livers. The model incorporated data from published studies and the United Network for Organ Sharing (UNOS). We found that accepting any liver regardless of HCV status versus accepting only HCV-negative livers resulted in an increase in life expectancy when Model for End-Stage Liver Disease (MELD) was ≥20, and the benefit was highest at MELD 28 (0.172 additional life-years). The magnitude of clinical benefit was greater in UNOS regions with higher HCV-positive donor organ rates, that is, Regions 1, 2, 3, 10, and 11. Sensitivity analysis demonstrated that model outcomes were robust.
Conclusion: Transplanting HCV-positive livers into HCV-negative patients with preemptive DAA therapy could improve patient survival on the LT waiting list. Our analysis can help inform clinical trials and minimize patient harm. (Hepatology 2018;67:2085-2095).
(© 2017 by the American Association for the Study of Liver Diseases.)
Databáze: MEDLINE
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