Liver transplantation for chronic hepatitis C virus infection in the United States 2002–2014: An analysis of the UNOS/OPTN registry

Georg Dultz, Barry I. Graubard, Paul Martin, Martin Walter Welker, Johannes Vermehren, Stefan Zeuzem, Katherine A. McGlynn, Tania M. Welzel

Research output: Contribution to journalArticle

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Abstract

Chronic hepatitis C virus (HCV) infection is a leading cause for orthotopic liver transplantation (OLT) in the U.S. We investigated characteristics of HCV-infected patients registered for OLT, and explored factors associated with mortality. Data were obtained from the United Network for Organ Sharing and Organ Procurement and Transplantation network (UNOS/ OPTN) registry. Analyses included 41,157 HCV-mono-infected patients ≥18 years of age listed for cadaveric OLT between February 2002 and June 2014. Characteristics associated with pre- and post-transplant survival and time trends over the study period were determined by logistic and Cox proportional hazard regression analyses and Poisson regressions. Most patients were white (69.1%) and male (70.8%). At waitlist registration, mean age was 54.6 years and mean MELD was 16. HCC was recorded in 26.9% of the records. A total of 51.2% of the patients received an OLT, 21.0% died or were too sick; 15.6% were delisted and 10.4% were still waiting. Factors associated with increased waitlist mortality were older age, female gender, blood type 0, diabetes, no HCC and transplant region (p<0.001). OLT recipient characteristics associated with increased risk for post OLT mortality were female gender, age, diabetes, race (p<0,0001), and allocation MELD (p = 0.005). Donor characteristics associated with waitlist mortality included age, ethnicity (p<0.0001) and diabetes (p<0.03). Waitlist registrations and OLTs for HCC significantly increased from 14.4% to 37.3% and 27.8% to 38.5%, respectively (p<0.0001). Pre- and post-transplant survival depended on a variety of patient-, donor-, and allocation- characteristics of which most remain relevant in the DAA-era. Still, intensified HCV screening strategies and timely and effective treatment of HCV are highly relevant to reduce the burden of HCV-related OLTs in the U.S.

Original languageEnglish (US)
Article numbere0186898
JournalPLoS One
Volume12
Issue number10
DOIs
StatePublished - Oct 1 2017

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chronic hepatitis C
liver transplant
Hepatitis C virus
Chronic Hepatitis C
Virus Diseases
Transplants
Viruses
Hepacivirus
Liver
Liver Transplantation
Registries
Medical problems
infection
diabetes
Mortality
Tissue Donors
Tissue and Organ Procurement
gender
blood groups
Organ Transplantation

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Liver transplantation for chronic hepatitis C virus infection in the United States 2002–2014 : An analysis of the UNOS/OPTN registry. / Dultz, Georg; Graubard, Barry I.; Martin, Paul; Welker, Martin Walter; Vermehren, Johannes; Zeuzem, Stefan; McGlynn, Katherine A.; Welzel, Tania M.

In: PLoS One, Vol. 12, No. 10, e0186898, 01.10.2017.

Research output: Contribution to journalArticle

Dultz, Georg ; Graubard, Barry I. ; Martin, Paul ; Welker, Martin Walter ; Vermehren, Johannes ; Zeuzem, Stefan ; McGlynn, Katherine A. ; Welzel, Tania M. / Liver transplantation for chronic hepatitis C virus infection in the United States 2002–2014 : An analysis of the UNOS/OPTN registry. In: PLoS One. 2017 ; Vol. 12, No. 10.
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abstract = "Chronic hepatitis C virus (HCV) infection is a leading cause for orthotopic liver transplantation (OLT) in the U.S. We investigated characteristics of HCV-infected patients registered for OLT, and explored factors associated with mortality. Data were obtained from the United Network for Organ Sharing and Organ Procurement and Transplantation network (UNOS/ OPTN) registry. Analyses included 41,157 HCV-mono-infected patients ≥18 years of age listed for cadaveric OLT between February 2002 and June 2014. Characteristics associated with pre- and post-transplant survival and time trends over the study period were determined by logistic and Cox proportional hazard regression analyses and Poisson regressions. Most patients were white (69.1{\%}) and male (70.8{\%}). At waitlist registration, mean age was 54.6 years and mean MELD was 16. HCC was recorded in 26.9{\%} of the records. A total of 51.2{\%} of the patients received an OLT, 21.0{\%} died or were too sick; 15.6{\%} were delisted and 10.4{\%} were still waiting. Factors associated with increased waitlist mortality were older age, female gender, blood type 0, diabetes, no HCC and transplant region (p<0.001). OLT recipient characteristics associated with increased risk for post OLT mortality were female gender, age, diabetes, race (p<0,0001), and allocation MELD (p = 0.005). Donor characteristics associated with waitlist mortality included age, ethnicity (p<0.0001) and diabetes (p<0.03). Waitlist registrations and OLTs for HCC significantly increased from 14.4{\%} to 37.3{\%} and 27.8{\%} to 38.5{\%}, respectively (p<0.0001). Pre- and post-transplant survival depended on a variety of patient-, donor-, and allocation- characteristics of which most remain relevant in the DAA-era. Still, intensified HCV screening strategies and timely and effective treatment of HCV are highly relevant to reduce the burden of HCV-related OLTs in the U.S.",
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