Acute cellular rejection in hepatitis C recipients following liver transplantation in the era of direct‐acting antivirals: chronological analysis of the United Network for Organ Sharing database

• Published in: Journal of hepato-biliary-pancreatic sciences 2019-09, Vol.26 (9), p.393-400
• Main Authors: Tanaka, Tomohiro, Voigt, Michael D.
• Format: Article
• Language: English
• Subjects: Acute cellular rejection; Antiviral Agents - therapeutic use; Direct-acting antivirals; Female; Graft Rejection - epidemiology; Graft Rejection - mortality; Graft Survival; Hepatitis; Hepatitis C; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - mortality; Hepatitis C, Chronic - surgery; Humans; Interferon; Interferons - therapeutic use; Liver transplantation; Liver Transplantation - mortality; Liver transplants; Male; Middle Aged; Recurrence; Retrospective Studies; Risk Factors; Transplants & implants; United States - epidemiology
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1002/jhbp.645

Introduction Interferon (IFN) treatment for liver transplant (LT) recipients with hepatitis C virus (HCV) increases acute cellular rejection (ACR) and worsens graft and patient survival. It is unknown if direct‐acting antivirals (DAAs) affect rejection rates or post‐transplant survival. Method The United Network for Organ Sharing STAR files of December 2017 (n = 25,916) were analyzed. Results Compared with non‐HCV‐LT, HCV‐LT survival was worse in the IFN‐era (2007–2008) and IFN+DAA‐era (2011), but not in the DAA‐era (2014–2015). ACR6m rate has been less frequent in newer eras and was lower in HCV‐LT than in non‐HCV‐LT in both the DAA‐era (6.9% vs. 9.3%, P < 0.001) and in the IFN+DAA‐era (8.8% vs. 11.8%, P = 0.001), but not in the IFN‐era (10.8% vs. 11.0%, P = 0.39). HCV‐LT recipients who had ACR6m had worse 2‐year survival than those without ACR6m, in the IFN‐era (80.0% vs. 88.4%, P < 0.0001) and in the IFN+DAA‐era (81.4% vs. 89.2%, P < 0.01) but not in the DAA‐era (90.4% vs. 93.2%, P = 0.085). Cox proportional hazard model identified ACR6m as independent risk factor for mortality in HCV‐LT in the IFN‐era (HR = 1.88, P ≤ 0.001) and in the IFN+DAA‐era (HR = 1.84, P = 0.005), but not in the DAA‐era (P = n.s.). Conclusions Two‐year survival of HCV‐LT recipients were significantly better in the DAA‐era; these were associated with reduced rate and impact of ACR6m. Highlight Acute cellular rejection and recurrent hepatitis C following liver transplantation result in poor outcomes, while the impact of direct‐acting antivirals has not been well described. Tanaka and Voigt reported that the incidence of early rejection and subsequent graft loss in liver transplant recipients with hepatitis C has been significantly reduced.