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

D. A. Axelrod, M. A. Schnitzler, T. Alhamad, F. Gordon, R. D. Bloom, G. P. Hess, H. Xiao, M. Nazzal, D. L. Segev, V. R. Dharnidharka, A. S. Naik, N. N. Lam, R. Ouseph, B. L. Kasiske, C. M. Durand, K. L. Lentine

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

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 1.85 2.10 , P <.0001) and death (aHR 1.47 1.68 1.91 , P <.0001). Post-DAA, HCV treatment was not associated with death (aHR 0.34 0.67 1.32 , P =.25) or graft failure (aHR 0.32 0.64 1.26 , 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 0.43 0.95 , P =.04) and graft loss by 46% ( 0.27 0.54 1.07 , 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.

Original languageEnglish
Pages (from-to)2473-2482
Number of pages10
JournalAmerican Journal of Transplantation
Volume18
Issue number10
DOIs
StatePublished - Oct 2018

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

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