The impact of direct‐acting antiviral agents on liver and kidney transplant costs and outcomes. Issue 10 (29th May 2018)

• Record Type: Journal Article
• Authors: Axelrod, D. A.; Schnitzler, M. A.; Alhamad, T.; Gordon, F.; Bloom, R. D.; Hess, G. P.; Xiao, H.; Nazzal, M.; Segev, D. L.; Dharnidharka, V. R.; Naik, A. S.; Lam, N. N.; Ouseph, R.; Kasiske, B. L.; Durand, C. M.; Lentine, K. L.
• Is Part Of: American journal of transplantation. Volume 18:Issue 10(2018)
• Page Start: 2473
• Page End: 2482
• Publication Date: 2018-05-29
• Subjects: 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; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.14895
• Languages: English
• ISSNs: 1600-6135

Abstract

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. Abstract : Examination of integrated US transplant registry data and records from a nationwide pharmacy claims warehouse demonstrates patterns of improved patient and graft survival in HCV‐positive liver and kidney transplant recipients treated after introduction of direct‐acting antiviral medications, but relatively limited access to these expensive medications among patients most likely to benefit. Brown offers comments in his editorial on page 2382 .