Direct-acting antiviral agents have facilitated the utilization of hepatitis C virus (HCV)+ organs in HCV nucleic acid amplification test (NAT)– recipients. We evaluated trends in HCV NAT+ listing and its impact on transplant probability, waitlist mortality, and likelihood of receiving HCV NAT+ organs using the United Network for Organ Sharing data set of adult patients waitlisted for liver transplantation from January 2016 to September 2023. Multivariable regression models accounting for competing risks were fit to study waitlist outcomes. Initially, 21 776 patients were listed for HCV NAT+ organs whereas 45 378 were not. The percentage of waitlisted patients listed for these organs increased significantly from 2016 to 2023 (8.8% to 60.8%, P < .001). Initial HCV NAT+ listing was associated with a waitlist mortality benefit in 2021-2023 (subhazard ratio 0.73, 95% CI 0.68-0.79, P < .001) and 17% reduced hazard of overall mortality (hazard ratio 0.83, 95% CI 0.78-0.89, P < .001). Sixteen percent of the total protective effect associated with HCV NAT+ listing on overall survival was mediated through actual receipt of HCV NAT+ organs (total excess relative risk of –0.160 and a pure indirect effect of –0.026; P < .001). Patients not listed for HCV NAT+ organs in the modern era are relatively disadvantaged in terms of waitlist outcomes. Although listings have risen over time, there remains center-level and geographic variation.

中文翻译：

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候选丙型肝炎病毒核酸扩增检测 （NAT）+ 列表的趋势及其对肝移植候补名单结果的相关影响


直接作用的抗病毒药物促进了丙型肝炎病毒 （HCV）+ 器官在 HCV 核酸扩增测试 （NAT） 接受者中的利用。我们使用 2016 年 1 月至 2023 年 9 月等待肝移植成年患者的器官共享联合网络数据集评估了 HCV NAT+ 清单的趋势及其对移植概率、候补名单死亡率和接受 HCV NAT+ 器官的可能性的影响。考虑竞争风险的多变量回归模型适合研究候补名单结果。最初，21 776 名患者被列入 HCV NAT+ 器官名单，而 45 378 名患者未被列入。从 2016 年到 2023 年，这些器官的候补患者百分比显着增加 （8.8% 至 60.8%，P < .001）。初始 HCV NAT+ 列表与 2021-2023 年的候补名单死亡率获益相关 （亚风险比 0.73,95% CI 0.68-0.79，P < .001） 和总死亡风险降低 17% （风险比 0.83,95% CI 0.78-0.89，P < .001）。与 HCV NAT+ 列表相关的总保护作用对总生存期的 16% 是通过实际接受 HCV NAT+ 器官介导的（总超额相对风险为 -0.160，纯间接效应为 -0.026;P < .001）.现代未被列入 HCV NAT+ 器官名单的患者在候补名单结果方面相对处于劣势。尽管房源数量随着时间的推移而增加，但仍然存在中心级别和地理差异。