Date: Monday, June 4, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
It is unclear whether patients with chronic hepatitis C virus (HCV) infection and end-stage renal disease (ESRD) should be treated for HCV before transplant or should be transplanted with HCV+ organ and treated for HCV afterwards. The aim of this study was to evaluate the optimal HCV treatment strategy and timing in patients listed for kidney transplantation.
A Markov model with 75 transition states was built to compare the strategy of transplanting HCV-infected patients with HCV+ deceased donor kidneys, followed by anti-viral therapy for HCV versus a strategy of treating HCV-infected patients prior to transplant, then waiting for an HCV− deceased donor kidney. We performed the analysis on a hypothetical cohort of HCV infected patients receiving hemodialysis. HCV treatment included direct-acting antivirals based on genotype. Distributions of age, gender, race, and HCV genotype were based on national data from the United States. The analysis used a lifelong time horizon; main outcome measures were effectiveness measured in quality adjusted life years (QALYs), and costs in 2017 US dollars.
In HCV infected patients, delaying HCV treatment after kidney transplantation with HCV+ organ was more effective and less costly than HCV antiviral treatment prior to transplantation. In the base case, a 58-year-old male receiving hemodialysis would gain an average of 0.22 quality-adjusted life years with lifetime cost savings of $24,358 with the strategy of HCV treatment after transplantation. The superiority of the transplant with HCV+ kidney strategy was robust in sensitivity analyses of the main model parameters. In probabilistic sensitivity analyses of 10,000 second-order Monte Carlo simulations, transplantation with an HCV+ donor kidney was preferred over HCV treatment followed by kidney transplantation with an HCV− donor kidney 92.9 % of the time.
Although new effective antiviral agents for HCV are available for patients with ESRD, the shorter waiting time in case of transplantation with HCV+ deceased donor kidneys results in higher quality-adjusted life expectancy and lower cost compared with a strategy of HCV treatment prior to transplantation. In the current age of increasing organ demand that far outstrips donor supply, a strategy of transplantation of HCV+ kidneys followed by treatment of HCV infection
may be both effective and cost saving.
CITATION INFORMATION: Eckman M., Woodle E., Thakar C., Paterno F., Sherman K. Timing of Treatment for Chronic Hepatitis C Infection in Patients with End-Stage Renal Disease Awaiting Transplantation Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Eckman M, Woodle E, Thakar C, Paterno F, Sherman K. Timing of Treatment for Chronic Hepatitis C Infection in Patients with End-Stage Renal Disease Awaiting Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/timing-of-treatment-for-chronic-hepatitis-c-infection-in-patients-with-end-stage-renal-disease-awaiting-transplantation/. Accessed February 28, 2021.
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