J. Campsen1, H. Thiesset1, R. Kim1 1University Of Utah,Transplantation And Advanced Hepatobiliary Surgery,Salt Lake City, UT, USA
Introduction:
It is commonly recognized that recurrent hepatitis c after transplantation is universal and immediate (1). The disease process within the liver is made worse after transplantation and accounts for 30% of transplants having cirrhosis within five years (2-4). Changes in antiviral treatment before transplantation show promising results, but has yet to eliminate the threat against the newly implanted organ. Furthermore recurrent hepatitis c after liver transplantation has a large financial impact on patients and the healthcare system. A national estimate for liver transplantation and first year costs can range from $300,000-$500, 000 without significant complications such as recurrent hepatitis c (5). We aimed to examine the financial impact of recurrent hepatitis c after transplantation and show one center’s experience.
Methods:
After approval from the University of Utah Institutional Review Board and as part of a clinical trial (6), patients underwent standard of care antiviral therapy with sofosbuvir and ribavirin before liver transplantation. Patients 1& 2 showed non-detectable levels of hepatitis C before inclusion in the clinical trial. The first patient was randomized to control and the second was randomized to 300mg of Civacir® Polyclonal Immune Globulin (IgG) and received 16 doses.
Results:
Patient 1 who was randomized to control, had recurrent hepatitis c detected at day six post liver transplantation. The control patient had significant complications after surgery due to the recurrent hepatitis c including multiple hospitalizations at an estimated cost of $140, 408.00. Furthermore, this patient required subsequent re-treatment with antiviral therapy at a national average cost of $169,000(7) (Table) for 24 weeks of treatment. The patient who received Civacir® did not have recurrent hepatitis c within the first six months of follow up and study completion.
Conclusion:
Two patients with similar standard of care protocols were enrolled in a clinical trial to prevent recurrent hepatitis c. In our experience, Civacir® proved effective in preventing recurrent hepatitis c in the transplanted liver and further prevented subsequent costs associated with treatment and patient care. The potential impact of Civacir® could eliminate the need for re-transplantation and hundreds of thousands of dollars to the healthcare system.
