Trends in liver transplantation for hepatitis C in a country with reduced access to direct‐acting antiviral agents
Background Hepatitis C virus (HCV)‐related cirrhosis is a leading indication for liver transplantation (LT) worldwide. Access to effective HCV treatment is inequitable globally. We aimed to analyze whether the introduction of effective HCV treatment caused an impact in LT trends in a middle‐income c...
Saved in:
Published in | Clinical transplantation Vol. 32; no. 4; pp. e13230 - n/a |
---|---|
Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Denmark
01.04.2018
|
Subjects | |
Online Access | Get full text |
Cover
Loading…
Abstract | Background
Hepatitis C virus (HCV)‐related cirrhosis is a leading indication for liver transplantation (LT) worldwide. Access to effective HCV treatment is inequitable globally. We aimed to analyze whether the introduction of effective HCV treatment caused an impact in LT trends in a middle‐income country.
Methods
Cross‐sectional analysis of all adult patients who were listed/received a LT in Argentina for HCV, alcohol‐related liver disease (ALD), or autoimmune hepatitis/primary biliary cirrhosis (AIH/PBC) from 2007 to 2017. Joinpoint regression analysis was used to identify changes in the cumulative incidence rates in waiting list (WL) registration, WL mortality, and LT.
Results
Liver transplantation WL for HCV increased significantly between 2007 and 2014, with an annual percentage change (APC) +7.8%, P = .01, followed by a downward slope from 2014 to 2017 with an APC −9.8%, P = .1. There were no significant changes in WL mortality. LT trends remained stable. LT for HCV without MELD exception points for HCC decreased (APC −6.6%, P = .01), whereas LT for HCV with HCC exception points increased (APC +11.1, P = .01) during the study period.
Conclusion
Waiting list and LT for HCV without HCC decreased, whereas LT for HCV and HCC increased; this may be related to selective antiviral treatment access for patients with advanced fibrosis. |
---|---|
AbstractList | Background
Hepatitis C virus (HCV)‐related cirrhosis is a leading indication for liver transplantation (LT) worldwide. Access to effective HCV treatment is inequitable globally. We aimed to analyze whether the introduction of effective HCV treatment caused an impact in LT trends in a middle‐income country.
Methods
Cross‐sectional analysis of all adult patients who were listed/received a LT in Argentina for HCV, alcohol‐related liver disease (ALD), or autoimmune hepatitis/primary biliary cirrhosis (AIH/PBC) from 2007 to 2017. Joinpoint regression analysis was used to identify changes in the cumulative incidence rates in waiting list (WL) registration, WL mortality, and LT.
Results
Liver transplantation WL for HCV increased significantly between 2007 and 2014, with an annual percentage change (APC) +7.8%, P = .01, followed by a downward slope from 2014 to 2017 with an APC −9.8%, P = .1. There were no significant changes in WL mortality. LT trends remained stable. LT for HCV without MELD exception points for HCC decreased (APC −6.6%, P = .01), whereas LT for HCV with HCC exception points increased (APC +11.1, P = .01) during the study period.
Conclusion
Waiting list and LT for HCV without HCC decreased, whereas LT for HCV and HCC increased; this may be related to selective antiviral treatment access for patients with advanced fibrosis. Abstract Background Hepatitis C virus ( HCV )‐related cirrhosis is a leading indication for liver transplantation ( LT ) worldwide. Access to effective HCV treatment is inequitable globally. We aimed to analyze whether the introduction of effective HCV treatment caused an impact in LT trends in a middle‐income country. Methods Cross‐sectional analysis of all adult patients who were listed/received a LT in Argentina for HCV , alcohol‐related liver disease ( ALD ), or autoimmune hepatitis/primary biliary cirrhosis ( AIH / PBC ) from 2007 to 2017. Joinpoint regression analysis was used to identify changes in the cumulative incidence rates in waiting list ( WL ) registration, WL mortality, and LT . Results Liver transplantation WL for HCV increased significantly between 2007 and 2014, with an annual percentage change ( APC ) +7.8%, P = .01, followed by a downward slope from 2014 to 2017 with an APC −9.8%, P = .1. There were no significant changes in WL mortality. LT trends remained stable. LT for HCV without MELD exception points for HCC decreased ( APC −6.6%, P = .01), whereas LT for HCV with HCC exception points increased ( APC +11.1, P = .01) during the study period. Conclusion Waiting list and LT for HCV without HCC decreased, whereas LT for HCV and HCC increased; this may be related to selective antiviral treatment access for patients with advanced fibrosis. BACKGROUNDHepatitis C virus (HCV)-related cirrhosis is a leading indication for liver transplantation (LT) worldwide. Access to effective HCV treatment is inequitable globally. We aimed to analyze whether the introduction of effective HCV treatment caused an impact in LT trends in a middle-income country. METHODSCross-sectional analysis of all adult patients who were listed/received a LT in Argentina for HCV, alcohol-related liver disease (ALD), or autoimmune hepatitis/primary biliary cirrhosis (AIH/PBC) from 2007 to 2017. Joinpoint regression analysis was used to identify changes in the cumulative incidence rates in waiting list (WL) registration, WL mortality, and LT. RESULTSLiver transplantation WL for HCV increased significantly between 2007 and 2014, with an annual percentage change (APC) +7.8%, P = .01, followed by a downward slope from 2014 to 2017 with an APC -9.8%, P = .1. There were no significant changes in WL mortality. LT trends remained stable. LT for HCV without MELD exception points for HCC decreased (APC -6.6%, P = .01), whereas LT for HCV with HCC exception points increased (APC +11.1, P = .01) during the study period. CONCLUSIONWaiting list and LT for HCV without HCC decreased, whereas LT for HCV and HCC increased; this may be related to selective antiviral treatment access for patients with advanced fibrosis. |
Author | Biggins, Scott W. Posadas‐Martínez, Maria L. Marciano, Sebastián Dirchwolf, Melisa Giunta, Diego H. Ruf, Andrés E. |
Author_xml | – sequence: 1 givenname: Melisa orcidid: 0000-0002-9083-3561 surname: Dirchwolf fullname: Dirchwolf, Melisa email: mdirchwolf@outlook.com organization: Hospital Privado de Rosario – sequence: 2 givenname: Sebastián surname: Marciano fullname: Marciano, Sebastián organization: Hospital Italiano – sequence: 3 givenname: Diego H. surname: Giunta fullname: Giunta, Diego H. organization: Hospital Italiano – sequence: 4 givenname: Maria L. surname: Posadas‐Martínez fullname: Posadas‐Martínez, Maria L. organization: Hospital Italiano – sequence: 5 givenname: Scott W. surname: Biggins fullname: Biggins, Scott W. organization: University of Washington – sequence: 6 givenname: Andrés E. surname: Ruf fullname: Ruf, Andrés E. organization: Fundación para la Docencia e Investigación de las Enfermedades del Hígado (FUNDIEH) |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29485711$$D View this record in MEDLINE/PubMed |
BookMark | eNp1kMtOAjEUhhuDkYsufAHTpS6AXhhol4Z4S0hMDK4nnfYM1AwdbDsQdj6Cz-iTWATdeTbnki9fcv4uarnaAUKXlAxoqqGOfkA54-QEdSiXsk8IZS3UIZKwNI95G3VDeEvXMR1nZ6jN5EhkE0o7KM49OBOwdbiyG_A4euXCulIuqmhrh8va4yWs0xJtwNM9qLCuGxf9Dm9tXGIPptFgsNIaQsCxxsZ60PHr41PpaN0CJ5ndWK8qrBbgYjhHp6WqAlwcew-93t_Np4_92fPD0_R21tecZaTPgUhhGOeaUMIEFCrLlCyLEmhhlFJSjoURpqDESAN0wkcmM6BFkYEcGZbxHro-eNe-fm8gxHxlg4YqfQd1E3JGiBBiwiVL6M0B1b4OwUOZr71dKb_LKcn3Iecp5Pwn5MReHbVNsQLzR_6mmoDhAdjaCnb_m_Lp_OWg_Ab434sx |
CitedBy_id | crossref_primary_10_1016_j_aohep_2018_11_003 crossref_primary_10_1016_j_aohep_2021_100344 crossref_primary_10_2807_1560_7917_ES_2019_24_41_1900176 |
Cites_doi | 10.1056/NEJM199603143341104 10.1111/apt.13343 10.1002/hep.28923 10.1111/liv.13310 10.4254/wjh.v9.i7.352 10.1016/j.jhep.2016.01.029 10.1097/MEG.0000000000000272 10.1186/s12916-017-0815-7 10.1002/hep.23744 10.1002/hep.26986 10.1016/j.jhep.2016.05.010 10.1002/cpt.185 10.1097/TP.0000000000000198 10.1111/acer.13013 10.1007/s10620-014-3361-6 10.1001/jama.2012.144878 10.1002/lt.23551 |
ContentType | Journal Article |
Copyright | 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd |
Copyright_xml | – notice: 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd |
DBID | NPM AAYXX CITATION 7X8 |
DOI | 10.1111/ctr.13230 |
DatabaseName | PubMed CrossRef MEDLINE - Academic |
DatabaseTitle | PubMed CrossRef MEDLINE - Academic |
DatabaseTitleList | CrossRef MEDLINE - Academic |
Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database |
DeliveryMethod | fulltext_linktorsrc |
EISSN | 1399-0012 |
EndPage | n/a |
ExternalDocumentID | 10_1111_ctr_13230 29485711 CTR13230 |
Genre | article Journal Article |
GroupedDBID | --- .3N .GA .GJ .Y3 05W 0R~ 10A 1OC 29B 31~ 33P 36B 3SF 4.4 50Y 50Z 51W 51X 52M 52N 52O 52P 52R 52S 52T 52U 52V 52W 52X 53G 5GY 5HH 5LA 5RE 5VS 66C 6J9 702 7PT 8-0 8-1 8-3 8-4 8-5 8UM 930 A01 A03 AAESR AAEVG AAHHS AAKAS AANLZ AAONW AASGY AAXRX AAZKR ABCQN ABCUV ABDBF ABEML ABJNI ABLJU ABPVW ABQWH ABXGK ACAHQ ACBWZ ACCFJ ACCZN ACGFO ACGFS ACGOF ACMXC ACPOU ACSCC ACXBN ACXQS ADBBV ADBTR ADEOM ADIZJ ADKYN ADMGS ADOZA ADXAS ADZCM ADZMN ADZOD AEEZP AEGXH AEIGN AEIMD AENEX AEQDE AEUQT AEUYR AFBPY AFEBI AFFPM AFGKR AFPWT AFZJQ AHBTC AIACR AIAGR AITYG AIURR AIWBW AJBDE ALAGY ALMA_UNASSIGNED_HOLDINGS ALUQN AMBMR AMYDB ASPBG ATUGU AVWKF AZBYB AZFZN AZVAB BAFTC BDRZF BFHJK BHBCM BMXJE BROTX BRXPI BY8 C45 CAG COF CS3 D-6 D-7 D-E D-F DCZOG DPXWK DR2 DRFUL DRMAN DRSTM DU5 EAD EAP EBC EBD EBS EJD EMB EMK EMOBN ESX EX3 F00 F01 F04 F5P FEDTE FUBAC G-S G.N GODZA H.X HF~ HGLYW HVGLF HZI HZ~ IHE IX1 J0M J5H K48 KBYEO LATKE LC2 LC3 LEEKS LH4 LITHE LOXES LP6 LP7 LUTES LW6 LYRES MEWTI MK4 MRFUL MRMAN MRSTM MSFUL MSMAN MSSTM MXFUL MXMAN MXSTM N04 N05 N9A NF~ O66 O9- OIG OVD P2P P2W P2X P2Z P4B P4D Q.N Q11 QB0 R.K ROL RX1 SUPJJ SV3 TEORI TUS UB1 V8K W8V W99 WBKPD WHWMO WIH WIJ WIK WOHZO WOW WQJ WRC WVDHM WXI WXSBR XG1 YFH YUY ZGI ZXP ZZTAW ~IA ~WT NPM AAYXX CITATION 7X8 |
ID | FETCH-LOGICAL-c3250-3e098d233c01028eba55a9fbfe1bdaaa9968d8db10d9de1734d5dec8b5e94d253 |
IEDL.DBID | DR2 |
ISSN | 0902-0063 |
IngestDate | Sat Aug 17 00:11:02 EDT 2024 Fri Aug 23 00:58:55 EDT 2024 Sat Sep 28 08:40:45 EDT 2024 Sat Aug 24 01:09:06 EDT 2024 |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 4 |
Keywords | joinpoint regression analysis waiting list analysis hepatitis C direct-acting antivirals liver transplantation trends |
Language | English |
LinkModel | DirectLink |
MergedId | FETCHMERGED-LOGICAL-c3250-3e098d233c01028eba55a9fbfe1bdaaa9968d8db10d9de1734d5dec8b5e94d253 |
Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ORCID | 0000-0002-9083-3561 |
PMID | 29485711 |
PQID | 2008887392 |
PQPubID | 23479 |
PageCount | 8 |
ParticipantIDs | proquest_miscellaneous_2008887392 crossref_primary_10_1111_ctr_13230 pubmed_primary_29485711 wiley_primary_10_1111_ctr_13230_CTR13230 |
PublicationCentury | 2000 |
PublicationDate | April 2018 2018-04-00 20180401 |
PublicationDateYYYYMMDD | 2018-04-01 |
PublicationDate_xml | – month: 04 year: 2018 text: April 2018 |
PublicationDecade | 2010 |
PublicationPlace | Denmark |
PublicationPlace_xml | – name: Denmark |
PublicationTitle | Clinical transplantation |
PublicationTitleAlternate | Clin Transplant |
PublicationYear | 2018 |
References | 2015; 27 2017; 37 2015; 60 2017; 15 2015; 42 2017; 65 2015; 98 2016; 65 2016; 64 2014; 59 2016; 40 2012; 18 2017; 152 1996; 334 2017; 9 2010; 52 2014; 98 2012; 308 e_1_2_8_24_1 e_1_2_8_25_1 e_1_2_8_26_1 e_1_2_8_3_1 e_1_2_8_2_1 e_1_2_8_5_1 e_1_2_8_4_1 e_1_2_8_7_1 e_1_2_8_6_1 e_1_2_8_9_1 e_1_2_8_8_1 e_1_2_8_20_1 e_1_2_8_21_1 e_1_2_8_22_1 e_1_2_8_23_1 e_1_2_8_17_1 e_1_2_8_18_1 e_1_2_8_14_1 e_1_2_8_15_1 e_1_2_8_16_1 e_1_2_8_10_1 e_1_2_8_11_1 e_1_2_8_12_1 Ahmad OB (e_1_2_8_13_1) Goldberg D (e_1_2_8_19_1) 2017; 152 |
References_xml | – volume: 9 start-page: 352 year: 2017 end-page: 367 article-title: Future of liver disease in the era of direct acting antivirals for the treatment of hepatitis C publication-title: World J Hepatol – volume: 42 start-page: 889 year: 2015 end-page: 901 article-title: Improvement of liver function parameters in advanced HCV‐associated liver cirrhosis by IFN‐free antiviral therapies publication-title: Aliment Pharmacol Ther – volume: 40 start-page: 794 year: 2016 end-page: 805 article-title: Epidemiology, evolution, and long‐term survival of alcoholic cirrhosis patients submitted to liver transplantation in Southeastern Spain publication-title: Alcohol Clin Exp Res – volume: 18 start-page: 1471 year: 2012 end-page: 1478 article-title: Projected future increase in aging hepatitis C virus‐infected liver transplant candidates: a potential effect of hepatocellular carcinoma publication-title: Liver Transpl – volume: 98 start-page: 394 year: 2015 end-page: 402 article-title: Direct‐acting antiviral drugs for the treatment of chronic hepatitis C virus infection: interferon free is now publication-title: Clin Pharmacol Ther – volume: 15 start-page: 52 year: 2017 article-title: Hepatitis C‐related hepatocellular carcinoma in the era of new generation antivirals publication-title: BMC Med – volume: 59 start-page: 2188 year: 2014 end-page: 2195 article-title: Nonalcoholic steatohepatitis is the most rapidly growing indication for liver transplantation in patients with hepatocellular carcinoma in the U.S publication-title: Hepatology – volume: 334 start-page: 693 year: 1996 end-page: 699 article-title: Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis publication-title: N Engl J Med – volume: 64 start-page: 1224 year: 2016 end-page: 1231 article-title: Impact of direct acting antiviral therapy in patients with chronic hepatitis C and decompensated cirrhosis publication-title: J Hepatol – volume: 37 start-page: 130 issue: Suppl 1 year: 2017 end-page: 135 article-title: The future of liver transplantation for viral hepatitis publication-title: Liver Int – volume: 152 start-page: e1 issue: 1090–1099 year: 2017 article-title: Changes in the prevalence of hepatitis C virus infection, nonalcoholic steatohepatitis, and alcoholic liver disease among patients with cirrhosis or liver failure on the waitlist for liver transplantation publication-title: Gastroenterology – volume: 98 start-page: 241 year: 2014 end-page: 246 article-title: Liver transplantation in Latin America: the state‐of‐the‐art and future trends publication-title: Transplantation – volume: 308 start-page: 2584 year: 2012 end-page: 2593 article-title: Association between sustained virological response and all‐cause mortality among patients with chronic hepatitis C and advanced hepatic fibrosis publication-title: JAMA – volume: 65 start-page: 524 year: 2016 end-page: 531 article-title: Delisting of liver transplant candidates with chronic hepatitis C after viral eradication: a European study publication-title: J Hepatol – volume: 60 start-page: 573 year: 2015 end-page: 581 article-title: Lower incidence of hepatocellular carcinoma and cirrhosis in hepatitis C patients with sustained virological response by pegylated interferon and ribavirin publication-title: Dig Dis Sci – volume: 65 start-page: 804 year: 2017 end-page: 812 article-title: Reduction in liver transplant wait‐listing in the era of direct‐acting antiviral therapy publication-title: Hepatology – volume: 52 start-page: 833 year: 2010 end-page: 844 article-title: Outcome of sustained virological responders with histologically advanced chronic hepatitis C publication-title: Hepatology – volume: 27 start-page: 355 year: 2015 end-page: 360 article-title: Screening for liver cancer during transplant waiting list: a multicenter study from South America publication-title: Eur J Gastroenterol Hepatol – ident: e_1_2_8_21_1 doi: 10.1056/NEJM199603143341104 – ident: e_1_2_8_18_1 doi: 10.1111/apt.13343 – ident: e_1_2_8_14_1 – ident: e_1_2_8_11_1 – ident: e_1_2_8_8_1 doi: 10.1002/hep.28923 – ident: e_1_2_8_2_1 doi: 10.1111/liv.13310 – ident: e_1_2_8_3_1 doi: 10.4254/wjh.v9.i7.352 – volume: 152 start-page: e1 issue: 1090 year: 2017 ident: e_1_2_8_19_1 article-title: Changes in the prevalence of hepatitis C virus infection, nonalcoholic steatohepatitis, and alcoholic liver disease among patients with cirrhosis or liver failure on the waitlist for liver transplantation publication-title: Gastroenterology contributor: fullname: Goldberg D – ident: e_1_2_8_17_1 doi: 10.1016/j.jhep.2016.01.029 – ident: e_1_2_8_12_1 doi: 10.1097/MEG.0000000000000272 – ident: e_1_2_8_23_1 doi: 10.1186/s12916-017-0815-7 – ident: e_1_2_8_5_1 doi: 10.1002/hep.23744 – ident: e_1_2_8_26_1 doi: 10.1002/hep.26986 – ident: e_1_2_8_22_1 doi: 10.1016/j.jhep.2016.05.010 – ident: e_1_2_8_4_1 doi: 10.1002/cpt.185 – ident: e_1_2_8_10_1 – ident: e_1_2_8_25_1 doi: 10.1097/TP.0000000000000198 – volume-title: Age Standardization of Rates: A New Who Standard ident: e_1_2_8_13_1 contributor: fullname: Ahmad OB – ident: e_1_2_8_16_1 – ident: e_1_2_8_20_1 doi: 10.1111/acer.13013 – ident: e_1_2_8_6_1 doi: 10.1007/s10620-014-3361-6 – ident: e_1_2_8_15_1 – ident: e_1_2_8_7_1 doi: 10.1001/jama.2012.144878 – ident: e_1_2_8_9_1 – ident: e_1_2_8_24_1 doi: 10.1002/lt.23551 |
SSID | ssj0016165 |
Score | 2.2478411 |
Snippet | Background
Hepatitis C virus (HCV)‐related cirrhosis is a leading indication for liver transplantation (LT) worldwide. Access to effective HCV treatment is... Abstract Background Hepatitis C virus ( HCV )‐related cirrhosis is a leading indication for liver transplantation ( LT ) worldwide. Access to effective HCV... BACKGROUNDHepatitis C virus (HCV)-related cirrhosis is a leading indication for liver transplantation (LT) worldwide. Access to effective HCV treatment is... |
SourceID | proquest crossref pubmed wiley |
SourceType | Aggregation Database Index Database Publisher |
StartPage | e13230 |
SubjectTerms | direct‐acting antivirals hepatitis C joinpoint regression analysis liver transplantation trends waiting list analysis |
Title | Trends in liver transplantation for hepatitis C in a country with reduced access to direct‐acting antiviral agents |
URI | https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fctr.13230 https://www.ncbi.nlm.nih.gov/pubmed/29485711 https://search.proquest.com/docview/2008887392 |
Volume | 32 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3NS8MwFA9jJy9-4Nf8IooHLxlt06wtnmQ4hqCHscEOQkmaTIejkzY76Mk_wb_Rv8S8ZC1OEcRbD2lo-_Lyfi_9vd9D6JxLJoOQCRIZPEFCllEiOkqRSBqw64WS-RM4Gri96_RH4c2YjRvosqqFcfoQ9YEbeIbdr8HBuSi_OHmmi7ZJpSjk6yCkB4BoUEtHGSBj20gC7ZBAHF6qCgGLp75zNRb9AJireNUGnN4Guq8e1fFMntoLLdrZ6zcVx3--yyZaXwJRfOVWzhZqqHwbaUeRxdMcz4CwgbXVPp9xV6CUYwNx8aMCFraelrgLAzm2_SaKFwxnurgALVglMbedGLGeYxc1P97eoYYif8BmsilQi2eYQ11XuYNGvetht0-WfRlIRg1iIlR5SSwDSjMQpIuV4IzxZCImyheSc25SqFjGUvieTKTyI2pMLlUWC6aSUAaM7qJmPs_VPsI0UFEnCUQYSejDTkUC-ErKiMeZEl7YQmeVhdJnJ7-RVmmL-Wip_WgtdFrZLjXOAX88eK7mi9L22DS7qMGALbTnjFpPE4AuTuT7LXRhTfP7_Gl3OLAXB38feojWDLSKHcfnCDV1sVDHBr5ocWLX6Sf-f-11 |
link.rule.ids | 315,786,790,1382,27955,27956,46327,46751 |
linkProvider | Wiley-Blackwell |
linkToHtml | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3JTsMwEB0hOMCFRWxlNYgDl1RNHDeJxAUVUFkPqEhcUGTHLlRUKWrTA5z4BL6RL2HGbioWISFuOThWkvF43jhv3gDsSS10EArlRYgnvFBk3FN1Y7xII9ithVr4bToauLyqN2_Cs1txOwEHZS2M04cYH7iRZ9j9mhycDqQ_eXlW9KuYS3FM2KfQ3QW55dH1WDwKoYxtJEnEQ48i8UhXiHg841u_RqMfEPMrYrUh52QO7sqHdUyTx-qwUNXs5ZuO43_fZh5mR1iUHbrFswATJl-EwrFkWSdnXeJssMLKn3elq1HKGaJc9mCIiF10BqxBAyWzLSf6z4yOdVmf5GCNZtI2Y2RFj7nA-f76RmUU-T3DyTrELu4ySaVdgyW4OTluNZreqDWDl3EETR43tSTWAecZadLFRkkhZNJWbeMrLaXELCrWsVZ-TSfa-BFHq2uTxUqYJNSB4MswmfdyswqMByaqJ4EKI02t2LlKCGJpHck4M6oWVmC3NFH65BQ40jJzwY-W2o9WgZ3SeCn6B_30kLnpDQe2zSZupAgDK7DirDqeJiBpnMj3K7BvbfP7_GmjdW0v1v4-dBumm63Li_Ti9Op8HWYQacWO8rMBk0V_aDYRzRRqyy7aD9e88ZU |
linkToPdf | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1LS8NAEB5EQbz4wFd9ruLBS0qTzTYJnqRafCOi4EEIu5mtFksqbXrQkz_B3-gvcWe3KT4QxFsOmyXJ7Ox8s_nmG4AdiQKDUCgvMnjCC0XGPVXX2ovQgN1aiMJv0dHA-UX96CY8uRW3Y7BX1sI4fYjRgRt5ht2vycGfsPXJybOiVzWpFDf5-kRY5wFlXgdXI-0og2RsH0niHXoUiIeyQkTjGd36NRj9QJhfAauNOM0ZuCuf1RFNHquDQlWzl28yjv98mVmYHiJRtu-WzhyM6XweCseRZe2cdYixwQorft6RrkIpZwbjsgdNNOyi3WcNGiiZbTjRe2Z0qMt6JAarkUnbipEVXebC5vvrGxVR5PfMTNYmbnGHSSrs6i_ATfPwunHkDRszeBk3kMnjupbEGHCekSJdrJUUQiYt1dK-QimlyaFijFH5NUxQ-xE3NkedxUroJMRA8EUYz7u5XgbGAx3Vk0CFEVIjdq4SAliIkYwzrWphBbZLC6VPTn8jLfMW89FS-9EqsFXaLjXeQb88ZK67g75tsmm2UQMCK7DkjDqaJiBhnMj3K7BrTfP7_Gnj-sperPx96CZMXh4007Pji9NVmDIwK3Z8nzUYL3oDvW6gTKE27JL9ABxx8EQ |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Trends+in+liver+transplantation+for+hepatitis+C+in+a+country+with+reduced+access+to+direct-acting+antiviral+agents&rft.jtitle=Clinical+transplantation&rft.au=Dirchwolf%2C+Melisa&rft.au=Marciano%2C+Sebasti%C3%A1n&rft.au=Giunta%2C+Diego+H&rft.au=Posadas-Mart%C3%ADnez%2C+Maria+L&rft.date=2018-04-01&rft.eissn=1399-0012&rft.volume=32&rft.issue=4&rft.spage=e13230&rft_id=info:doi/10.1111%2Fctr.13230&rft_id=info%3Apmid%2F29485711&rft.externalDocID=29485711 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0902-0063&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0902-0063&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0902-0063&client=summon |