부산대학교 도서관

Direct‐acting antiviral medications (DAAs) have revolutionized care for hepatitis C positive (HCV+) liver (LT) and kidney (KT) transplant recipients. Scientific Registry of Transplant Recipients registry data were integrated with national pharmaceutical claims (2007‐2016) to identify HCVtreatments before January 2014 (pre‐DAA) and after (post‐DAA), stratified by donor (D) and recipient (R) serostatus and payer. Pre‐DAA, 18% of HCV+ LTrecipients were treated within 3 years and without differences by donor serostatus or payer. Post‐DAA, only 6% of D‐/R+ recipients, 19.8% of D+/R+ recipients with public insurance, and 11.3% with private insurance were treated within 3 years (P< .0001). LT recipients treated for HCVpre‐DAAexperienced higher rates of graft loss (adjusted hazard ratio [aHR] 1.341.852.10, P< .0001) and death (aHR1.471.681.91, P< .0001). Post‐DAA,HCVtreatment was not associated with death (aHR0.340.671.32, P= .25) or graft failure (aHR0.320.641.26, P= .20) in D+R+ LTrecipients. Treatment increased in D+R+ KTrecipients (5.5% pre‐DAAvs 12.9% post‐DAA), but did not differ by payer status. DAAs reduced the risk of death after D+/R+ KTby 57% (0.190.430.95, P= .04) and graft loss by 46% (0.270.541.07, P= .08). HCVtreatment with DAAs appears to improve HCV+ LTand KToutcomes; however, access to these medications appears limited in both LTand KTrecipients. Examination of integrated US transplant registry data and records from a nationwide pharmacy claims warehouse demonstrates patterns of improved patient and graft survival in HCV‐positive liver and kidney transplant recipients treated after introduction of direct‐acting antiviral medications, but relatively limited access to these expensive medications among patients most likely to benefit. Brown offers comments in his editorial on page 2382.