乌鸦传媒

For patients with hepatitis C virus (HCV) and end-stage renal disease, receiving an HCV-infected kidney was less costly and carried a slight survival bump compared with waiting for an uninfected kidney, a cost-effectiveness analysis found.

The study, which used a computer simulation model, reported that the average 57.8-year-old HCV patient would gain a 0.5 quality-adjusted life year if they received an HCV-infected kidney followed by treatment with direct-acting antivirals (DAAs) versus treatment while waiting for an uninfected kidney, according to Mark Eckman, MD, MS, of the University of Cincinnati Medical Center, and colleagues.

And this same patient would save around $41,591 in healthcare costs over their lifetime ($566,626 versus $608,217 discounted at 3% per year), the researchers wrote in .

While transplantation with an HCV-infected kidney was associated with a higher lifetime probability of dying from end-stage liver disease (5% versus 3.4% with an uninfected kidney), patients waiting for an uninfected kidney were met with longer wait times, which meant longer duration of dialysis and an increased probability of dying from chronic kidney disease (34.5% versus 29% with an infected kidney).

Due to this, the net benefit in quality-adjusted life years of choosing the strategy of implanting an infected kidney followed by HCV treatment was slightly more favorable compared to waiting for an uninfected kidney.

The analysis utilized a Markov transition model to compare the two treatment strategies for patients with HCV receiving hemodialysis. This included patients stratified across the 5 fibrosis stages of liver disease -- F0 through F4. Wait-list time estimates relied on data from a that found that for an infected kidney, patients waited a median of 231 days for a donor kidney compared with 771 days for an uninfected kidney. This resulted in a difference in dialysis duration of 2.1 years versus 2.6 years, respectively.

Patients waiting to receive an uninfected kidney would be treated prior to the transplant with genotype-guided therapy for 8, 12, or 16 weeks.

Comparatively, those who received an HCV-infected kidney would be subsequently treated 6 months after the transplant with a 12-week course of glecaprevir-pibrentasvir (three once-daily tablets of 100-mg glecaprevir and 40-mg pibrentasvir). The new pangenotypic DAA can be used in patients with end-stage renal disease, the authors noted.

"The results of this study are best understood by recognizing that most of these patients face higher risks from long-term dialysis than from untreated HCV," commented David Goldberg, MD, and Peter Reese, MD, of Perelman School of Medicine in Philadelphia, in an .

However, they also noted that the opioid crisis has consequently affected the availability of HCV-infected kidneys unevenly across the U.S.

"As a result, each transplant center's staff should develop familiarity with the local availability of HCV-infected organs and use this information to counsel their HCV-infected patients," they recommended, adding that especially in areas where HCV-infected kidneys are "plentiful," providers should strongly consider accepting those kidneys for transplantation in these patients.

"If the availability of HCV-infected organs diminishes, the question of how best to time DAA treatment will need a fresh look," Goldberg and Reese concluded.