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Title: Turning the tide on hepatitis C-related liver transplantation: the return on investment in hepatitis C treatment in Australia and New Zealand.
Austin Authors: Howell, Jess;Majumdar, Avik;Fink, Michael A ;Byrne, Mandy;McCaughan, Geoff;Strasser, Simone I;Crawford, Michael;Hodgkinson, Peter;Stuart, Katherine A;Tallis, Caroline;Chen, John;Wigg, Alan;Jones, Robert M ;Jaques, Bryon;Jeffrey, Gary;Adams, Leon;Wallace, Michael C;Munn, Stephen;Gane, Ed;Thompson, Alex;Gow, Paul J 
Affiliation: South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, Australia
Queensland Liver Transplant Service, Princess Alexandra Hospital and Queensland Children's Hospital, Brisbane, Australia
Surgery (University of Melbourne)
Victorian Liver Transplant Unit
Department of Medicine, University of Melbourne, Melbourne, Australia
New Zealand Liver Transplant Service, Auckland City Hospital and Starship Children's Hospital, Auckland New Zealand
Medical School, University of Western Australia, Perth, Australia
WA Liver Transplant Service, Sir Charles Gairdner Hospital, Perth, Australia
AW Morrow GE and Liver Centre, University of Sydney, Sydney, Australia
Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney Australia
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
Disease Elimination Department, Burnet Institute, Melbourne, Australia
Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Australia
Department of Medicine, University of Auckland, Auckland New Zealand
New Zealand Liver Transplant Service, Auckland City Hospital and Starship Children's Hospital, Auckland New Zealand
Issue Date: 2022
Date: 2021-10-08
Publication information: Liver transplantation 2022; 28(2): 236-246
Abstract: 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. 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. 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). 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.
DOI: 10.1002/lt.26329
ORCID: 0000-0002-9684-4691
Journal: Liver Transplantation
PubMed URL: 34624175
Type: Journal Article
Appears in Collections:Journal articles

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