The number of adult liver transplants performed for HCV-related liver cirrhosis and HCC has reduced since universal access to DAAs was introduced in 2016 in Australia and New Zealand.
A retrospective study of all 5,318 adult liver transplants from the Australian and New Zealand Liver and Intestinal Liver Transplant Registry (ANZLITR) dataset between 1990 and 2019 has found 29% were performed for HCV.
The proportion of transplants for HCV increased from 9% in 1990 to 39% in 2012, remained steady between 2012 and 2014, then fell to 23% in 2019.
“Linear regression modelling showed that prior to introduction of DAAs, across the 1990-2015 time-period there was a significant mean increase of 3.5 adult liver transplants performed for HCV per year.”
“However, between 2016 to 2019 there was a significant mean decrease of 7.9 adult liver transplants per year for HCV (p<0.001).”
Similarly, the number of transplants for HCC increased steadily from 1995 to 2016, then fell through to 2019.
“This appeared to be driven by the more sizeable decrease in liver transplants for HCV-related HCC from 65 in 2016 to 50 in 2019,” the study said.
The study, published in Liver Transplantation, also found a decline in the number of HCV patients waitlisted for liver transplantation since 2016 compared to those waitlisted for liver transplantation for other liver diseases.
“Though the follow up duration after introduction of DAAs is relatively short, introduction of DAAs was associated with a 31% reduction in death after liver transplantation when adjusted for age category at transplant and presence of HCC (HR 0.7, 95% CI 0.5-1.0, p=0.05).”
The study, led by Dr Jess Howell from the University of Melbourne and Burnet Institute, said the decreasing requirement for transplantation due to HCV was a surrogate marker for the impact on DAA’s on HCV-related liver disease and HCC more broadly.
“Prior to 2016, the annual number and proportion of liver transplants performed for HCV steadily increased, however from 2016 there was a significant decline in the HCV-related liver transplantation rate.”
The study also showed an improved survival for all adult liver transplant recipients since 2016 which the investigators said was likely to be at least partly due to the introduction of DAA’s.
“As more people are cured of HCV prior to the development of cirrhosis, it is likely that we will continue to observe further decrease in numbers of HCV- related adult liver transplants,” they concluded.
“Sustained investment in universal access to DAAs is an important measure to reduce HCV-related morbidity and mortality worldwide.”