Date de publication

25 août 2020

Auteur(s)

Ivanics, T., Rizzari,M. et autres

Description

The success of direct‐acting antiviral (DAA) therapy has led to near‐universal cure for patients chronically infected with hepatitis C virus (HCV) and improved post‐liver transplant(LT) outcomes. We investigated the trends and outcomes of re‐transplantation in HCV and non‐HCV patients before and after the introduction of DAA. Adult patients who underwent re‐LT were identified in the OPTN/UNOS database. Multi‐organ transplants and patients with more than two total LTs were excluded. Two eras were defined, pre‐DAA(2009‐2012), and post‐DAA(2014‐2017). A total of 2,112 re‐LT patients were eligible(HCV: n=499 pre‐DAA and n=322 post‐DAA; non‐HCV: n=547 pre‐DAA and n=744 post‐DAA). HCV patients had both improved graft and patient survival after re‐LT in the post‐DAA era. One‐year graft survival was 69.8% pre‐DAA and 83.8% post‐DAA(p<0.001). One‐year patient survival was 73.1% pre‐DAA and 86.2% post‐DAA(p<0.001).Graft and patient survival was similar between eras for non‐HCV patients. When adjusted, the post‐DAA era represented an independent positive predictive factor for graft and patient survival(HR:0.67;p=0.005,and HR:0.65;p=0.004) only in HCV patients. The positive post‐DAA era effect was observed only in HCV patients with first graft loss due to disease recurrence(HR:0.31;p=0.002, HR 0.32;p=0.003, respectively). Among HCV patients, receiving a re‐LT in the post‐DAA era was associated with improved patient and graft survival.