scholarly journals Trends in Discard of Kidneys from Hepatitis C Viremic Donors in the United States

2021 ◽  
Vol 16 (2) ◽  
pp. 251-261 ◽  
Author(s):  
Su-Hsin Chang ◽  
Massini Merzkani ◽  
Krista L. Lentine ◽  
Mei Wang ◽  
David A. Axelrod ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Organ Procurement ◽  
Deceased Donor ◽  
The United States ◽  
Nucleic Acid Amplification ◽  
Direct Acting Antiviral ◽  
Successful Transplantation ◽  
Organ Procurement Organizations ◽  
Hcv Antibody ◽  
Direct Acting

Background and objectivesKidneys from hepatitis C virus (HCV) viremic donors have become more commonly accepted for transplant, especially after effective direct-acting antiviral therapy became available in 2014. We examined the contemporary trend of kidney discard from donors with HCV seropositivity and viremia.Design, setting, participants, & measurementsData from the Organ Procurement and Transplantation Network were used to identify deceased donor kidneys recovered for transplant. The exposure was donor HCV antibody status in the first analyses, and donor HCV antibody and viremia status in the second analyses. Multilevel, multivariable logistic regression was used to assess the association of these HCV exposure measures with kidney discard, adjusted for donor characteristics. Multilevel analyses were conducted to account for similar kidney discard pattern within clusters of organ procurement organizations and regions.ResultsAmong 225,479 kidneys recovered from 2005 to 2019, 5% were from HCV seropositive donors. Compared with HCV seronegative kidneys, the odds of HCV seropositive kidney discard gradually declined, from a multivariable-adjusted odds ratio (aOR) of 7.06 (95% confidence interval [95% CI], 5.65 to 8.81) in 2014, to 1.20 (95% CI, 1.02 to 1.42) in 2019. Among 82,090 kidneys with nucleic acid amplification test results in 2015–2019, 4% were from HCV viremic donors and 2% were from aviremic seropositive donors. Compared with HCV aviremic seronegative kidneys, the odds of HCV viremic kidney discard decreased from an aOR of 4.89 (95% CI, 4.03 to 5.92) in 2018, to 1.48 (95% CI, 1.22 to 1.81) in 2019. By 2018 and 2019, aviremic seropositive status was not associated with higher odds of discard (2018: aOR, 1.13; 95% CI, 0.88 to 1.45; and 2019: aOR, 0.97; 95% CI, 0.76 to 1.23).ConclusionsDespite the decrease in kidney discard in recent years, kidneys from viremic (compared with aviremic seronegative) donors still had 48% higher odds of discard in 2019. The potential of these discarded organs to provide successful transplantation should be explored.

Abstract 12659: Improved Heart Transplant Outcomes Among Patients With Hepatitis C Virus Infection in the Era of Direct-acting Antiviral Agents

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tomohiro Fujisaki ◽  
Takahisa Mikami ◽  
Toshiki Kuno ◽  
Noah Moss ◽  
Shinobu Itagaki
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Heart Transplant ◽  
Antiviral Agents ◽  
Nucleic Acid Amplification ◽  
Transplant Outcomes ◽  
Direct Acting Antiviral ◽  
Hcv Antibody ◽  
Direct Acting ◽  
Direct Acting Antiviral Agents

Introduction: The effect of hepatitis C virus (HCV) infection in recipients or donors on heart transplants is less known in the era after the introduction of direct-acting antiviral agents (DAAs). Methods: Using the United Network for Organ Sharing registry, 25,581 adult heart transplant recipients between 2005 and 2019 were identified. The trend in prevalence of HCV infected recipients and in utilization of HCV infected donors and their effect on the transplant outcomes were investigated in the pre-DAAs era versus the DAAs era separated by May 13, 2011, using Cox proportional hazard regression. Results: HCV antibody positive recipients (n=532, 2.1%) had stable prevalence ( P =0.18) with a higher mortality risk in the pre-DAAs era (50.8% versus 38.8% at 10 years; hazard ratio (HR), 1.50; 95% confidence interval (CI), 1.22-1.85; P <0.001), however not in the DAAs era (25.3% versus 28.4% at 7 years; HR, 0.96; 95% CI, 0.72-1.28; P =0.79) ( P interaction<0.001). Organ use from HCV antibody positive donors (n=375, 1.5%) was exclusively concentrated in the recent years ( P <0.001) and provided the similar mortality up to 2 years (15.7% versus 12.4%; HR, 0.96; 95% CI, 0.65-1.43; P =0.84) regardless of the recipient HCV antibody status. The similar findings were confirmed with a subgroup cohort with positive nucleic acid amplification test (NAT). Conclusions: In the DAAs era, positive HCV antibody in recipients did not adversely affect the long-term transplant outcomes. Graft utilization from positive HCV antibody or NAT positive donors are rapidly more prevalent and appeared to be promising up to 2 years post-transplant.

scholarly journals Absolute Insurer Denial of Direct-Acting Antiviral Therapy for Hepatitis C: A National Specialty Pharmacy Cohort Study

2018 ◽  
Vol 5 (6) ◽  
Author(s):  
Charitha Gowda ◽  
Stephen Lott ◽  
Matthew Grigorian ◽  
Dena M Carbonari ◽  
M Elle Saine ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hepatitis C ◽  
The United States ◽  
Public And Private ◽  
Commercial Insurance ◽  
Direct Acting Antiviral ◽  
Insurance Type ◽  
Specialty Pharmacy ◽  
Direct Acting ◽  
Over Time

Abstract Background Despite the availability of new direct-acting antiviral (DAA) regimens, changes in DAA reimbursement criteria, and a public health focus on hepatitis C virus (HCV) elimination, it remains unclear if public and private insurers have increased access to these therapies over time. We evaluated changes in the incidence of absolute denial of DAA therapy over time and by insurance type. Methods We conducted a prospective cohort study among patients who had a DAA prescription submitted from January 2016 to April 2017 to Diplomat Pharmacy, Inc., which provides HCV pharmacy services across the United States. The main outcome was absolute denial of DAA prescription, defined as lack of fill approval by the insurer. We calculated the incidence of absolute denial, overall and by insurance type (Medicaid, Medicare, commercial), for the 16-month study period and each quarter. Results Among 9025 patients from 45 states prescribed a DAA regimen (4702 covered by Medicaid, 1821 Medicare, 2502 commercial insurance), 3200 (35.5%; 95% confidence interval, 34.5%–36.5%) were absolutely denied treatment. Absolute denial was more common among patients covered by commercial insurance (52.4%) than Medicaid (34.5%, P &lt; .001) or Medicare (14.7%, P &lt; .001). The incidence of absolute denial increased across each quarter of the study period, overall (27.7% in first quarter to 43.8% in last quarter; test for trend, P &lt; .001) and for each insurance type (test for trend, P &lt; .001 for each type). Conclusions Despite the availability of new DAA regimens and changes in restrictions of these therapies, absolute denials of DAA regimens by insurers have remained high and increased over time, regardless of insurance type.

scholarly journals SO032THE DISCARD AND DECLINE OF HEPATITIS C VIRUS POSITIVE DONOR KIDNEYS IN THE UNITED STATES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Tarek Alhamad ◽  
Krista Lentine ◽  
David Axelrod ◽  
Sami Abdulnabi ◽  
Mark Schnitzler ◽  
...  
Keyword(s):  
United States ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Organ Procurement ◽  
Deceased Donor ◽  
The United States ◽  
Odds Ratios ◽  
Life Saving ◽  
Increasing Trend ◽  
Donor Characteristics

Abstract Background and Aims With more transplant centers in the United States are accepting hepatitis C virus infected (HCV+) deceased donor kidneys (dHCV+), the trend of non-utilization and decline of these organs have not been re-examined. Method We used data from the national Organ Procurement and Transplantation Network on deceased donor kidneys between Jan 2000 and Dec 2018 in the United States. Kidney non-utilization for HCV+ was defined as a positive donor HCV status and positive hepatitis as the reason for non-utilization. dHCV+ kidney decline was defined as a donor HCV+ status among kidneys recovered for transplantation but not transplanted. We assessed associations of a dHCV+ status with kidney non-utilization or decline, adjusted for donor characteristics (age, race, sex, body mass index, diabetes, hypertension, kidney donor profile index), using multivariable logistic regression. Results A total of 274,570 deceased donor kidneys procured for transplantation between 2000 and 2018 were identified. Among these kidneys, 4.1% were from dHCV+. Proportion of dHCV+ non-utilization among all non-utilized kidneys increased from 2000-2005 (3.9%) and then subsequently declined. This proportion increased slightly to 1.1% in 2014 and decreased to 0.5, 0.8, 0.4, 0.6% in 2015-2018, respectively. Multivariable-adjusted odds ratios for dHCV+ non-utilization and decline by year demonstrate consistently an increasing trend from 2000-2006 followed by a decreasing trend from 2006-2011 (Fig A-B). Multivariable-adjusted odds ratios for dHCV+ (compared to dHCV-) non-utilization and decline increased to 6.56 (95% CI 5.30-8.12) and 6.66 (95% CI 5.39-8.24), respectively, in 2012, and decreased to 2.32 (95% CI 2.01-2.69) and 2.28 (95% CI 1.98-2.64), respectively, in 2018. Conclusion dHCV+ non-utilization and decline have decreased in the last few years, particularly after 2014. 2018 had a historic lowest odds ratio for non-utilization and decline of dHCV+ organs, which reflects the increased acceptability of transplant centers to these kidneys. Overall, since 2014, the odds ratios for dHCV+ non-utilization and decline decreased by half. Yet, there is more room for decreasing the non-utilization and decline for these potentially life-saving organs.

Retransplantation outcomes for hepatitis C in the United States before and after direct‐acting antiviral introduction

2020 ◽  
Author(s):  
Tommy Ivanics ◽  
Michael Rizzari ◽  
Dilip Moonka ◽  
Abbas Al‐Kurd ◽  
Khortnal Delvecchio ◽  
...  
Keyword(s):  
United States ◽  
Hepatitis C ◽  
The United States ◽  
Direct Acting Antiviral ◽  
Before And After ◽  
Direct Acting

scholarly journals Underutilization of Hepatitis C Virus Seropositive Donor Kidneys in the United States in the Current Opioid Epidemic and Direct-Acting Antiviral Era

Diseases ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 62 ◽  
Author(s):  
Andrew Li ◽  
George Cholankeril ◽  
Xingxing Cheng ◽  
Jane Tan ◽  
Donghee Kim ◽  
...  
Keyword(s):  
United States ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
The United States ◽  
Opioid Epidemic ◽  
Direct Acting Antiviral ◽  
Direct Acting

scholarly journals 2899. Decreased Hepatitis C Virus-Associated Mortality in the US 2014–2017 After New Oral Direct-Acting Antiviral Era

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S82-S83
Author(s):  
Zainab Wasti ◽  
Dagan Coppock ◽  
Edgar Chou ◽  
Dong Heun Lee
Keyword(s):  
United States ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Linkage To Care ◽  
The United States ◽  
Ease Of Use ◽  
Hcv Infection ◽  
Race And Gender ◽  
Direct Acting Antiviral ◽  
Direct Acting

Abstract Background Due to the ease of use and low side effect profile of new direct-acting antivirals (DAA), cure rates for hepatitis C virus (HCV) infection have increased in recent years. However, limited data exist addressing the mortality associated with HCV infection since the advent of DAAs. This study examines multiple-cause-of-death (MCOD) data from 2014 to 2017 to describe changes in HCV-associated mortality in the United States. Methods We examined death certificate information from public use MCOD data obtained from the National Center for Health Statistics. All-cause mortality associated with HCV, as defined by ICD-10 codes (B17.1 and B18.2), was evaluated. The age-adjusted crude mortality rate was calculated. Overall HCV-associated mortality, stratified by race and gender, was analyzed. Results From 2014 to 2017, the number of deaths associated with HCV, as listed in death certificates decreased from 19,613 to 17,253. This represents an average of 4% decrease in mortality each year. Crude age-adjusted mortality decreased from 5.01 (95% CI 4.93–5.08) deaths per 100,000 people in 2014 to 4.13 (95% CI 4.07–4.20) deaths per 100,000 people in 2017. Males had age-adjusted mortality of 6.82 (95% CI 6.76–6.88) and females had age-adjusted mortality of 2.59 (95% CI 2.55–2.63). African Americans had age-adjusted mortality of 7.50 (95% CI 7.37–7.63), and whites had age-adjusted mortality of 4.39 (95% CI 4.35–4.42) during the three-year period. Conclusion After the introduction of DAAs in 2014, mortality associated with HCV significantly decreased in the United States. There were differences in mortality rates by gender and race, which may reflect differences in HCV seroprevalence. With the availability of effective, well-tolerated HCV treatment, aggressive HCV screening and linkage to care is warranted, especially in high-risk populations. Disclosures All Authors: No reported Disclosures.

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