The number of liver transplants gives us an indication of how many people in SF have a deseased or injured liver (i.e., a liver that no longer functions properly). Liver damange or failure due to HCV should be largely avoidable because of the introduction of direct-acting antivirals to treat and cure HCV. Liver transplants indicate that there is room to improve early interventions/strategies to prevent complications and address exacerbations due to HCV. 

Description of Data: The yearly number of liver transplants performed on SF residents. 

Time:

• Data time frame: 01/01/2007 - 05/31/2020
• Based on data as of 08/21/2020

Inclusion/Exclusion Criteria:

• Receipents of liver transplants: only includes people whos ZIP code of permanent residence at time of tranplant is a SF ZIP code
  • a list of 51 SF ZIP codes were sent to UNOS
• # of LT related to hepatitis C was identified in one of two ways, HCV-related diagnosis or viral testing. 
• HCV Serostatus Positive is used to include patients with a positive HCV antibody test. 
• HCV NAT (virtal testing) was not included. The UNOS research analyst ran the numbers and he found that only a small portion of recipients are tested for HCV NAT. 

Description of Data Source: United Network for Organ Sharing (UNOS) is the private, non-profit organization that manages the nation’s organ transplant system (the Organ Procurement and Transplantation Network (OPTN)) under contract with the federal government. UNOS maintains a database that contains all organ transplant data for every transplant event that occurs in the U.S. Reference: https://unos.org/ 

The excel data file can be found under File Attachments. 

Additional Notes: 

• HCV-related primary diagnosis was used identify patients where the physician felt the diagnosis was the primary reason the patient needed a liver transplant.  It could, however, miss any patients with a primary diagnosis that is not HCV related, even if they have HCV. These numbers were not used since there were less data using this method. The five UNOS codes used include:
  • 4104 - Acute Hepatic Necrosis (AHN) - Type C
  • 4106 – AHN – Type B and C
  • 4204 - Cirrhosis - Type C
  • 4206 – Cirrhosis – Type B and C
  • 4216  - Alcoholic Cirrhosis with Hepatitis C
• 2 codes - 4106 and 4206 - combine hep B and hep C in their diagnosis code. The final numbers for this method might be inflated since those two codes include hepatitis B diagnosis.