Fewer Viral Hepatitis Patients with End-stage Liver Disease

liver411

Are Awaiting Liver Transplants,Likely Due to Effective Hepatitis B Treatment

Fewer Viral Hepatitis Patients with End-stage Liver Disease Are Awaiting Liver
Transplants, Likely Due to Effective Hepatitis B Treatment

SUMMARY: Trends over time in the number of patients registering for the
liver transplant waiting list show a decrease in the proportion with end-stage
liver disease (ESLD), while the proportion with hepatocellular carcinoma (HCC)
has increased, researchers reported in the November 2009 issue of
Gastroenterology. The decline in ESLD was especially pronounced among patients
with hepatitis B, which the investigators attributed to widespread use of
effective antiviral therapy.


By Liz Highleyman
Over years or decades, chronic hepatitis B virus (HBV) and hepatitis C virus
(HCV) infection can progress to advanced liver disease and are major reasons
for liver transplants in the U.S. Other indications include alcoholic
hepatitis and liver toxicity (for example, due to acetaminophen or poisonous
mushrooms).
There has been significant progress in treating viral hepatitis over the past
decade, and infants are now routinely vaccinated against HBV (done as an
adolescent if not received earlier). But many people with HBV or HCV have not
been diagnosed, and a significant number of those who received treatment do
not achieve a sustained response, or "cure."
W. Ray Kim from the Mayo Clinic College of Medicine and colleagues
investigated whether the widespread adoption of antiviral therapies for
hepatitis B and C has affected liver transplant waiting list registration,
analyzing longitudinal trends for patients with hepatitis B and C and those
with non-viral liver disease.
The researchers performed a retrospective analysis of registry data from all
U.S. liver transplant centers, including all adult primary liver
transplantation candidates registered with the Organ Procurement and
Transplantation Network (OPTN) between 1985 and 2006.
Standardized incidence rates were calculated according to underlying disease
(HBV, HCV, and other) and indication for transplantation (fulminant liver
disease, ESLD, and HCC).
Results
Out of 113,927 unique waiting list registrants, 4793 (4.2%) had HBV, 40,923
(35.9%) had HCV, and the remaining 68,211 (59.9%) had neither virus.
The 3 groups were similar in age, but patients with viral hepatitis
(especially HBV) were more likely to be male.
The rate of waiting list registrations for ESLD and fulminant liver disease
decreased overall during the study period.
The decrease in registrations due to ESLD was most pronounced.
The decrease in registration for ESLD related to HCV was significantly larger
than that for ESLD related to non-viral causes.
In contrast, there was a persistent increase in waiting list registrations
for HCC.
The HCC increase was least dramatic among registrants with HBV.
Based on these findings, the study authors concluded, "The pattern of liver
transplantation waiting list registration among patients with hepatitis B
suggests that the widespread application of oral antiviral therapy for HBV
contributed to the decreased incidence of decompensated liver disease."
In their discussion, the researchers offered evidence that the trends were not
primarily attributable to changes in the organ allocation system (which tended
to favor patients with HCC compared with other causes).
They noted that another plausible explanation may be that a decreasing
proportion of patients are considered suitable candidates for liver
transplants, rather than there being fewer people who develop ESLD.
In the case of hepatitis C, other epidemiological data do not suggest a
decline in end-stage disease, so it may be that more HCV patients with ESLD
are considered to be too old or to have unacceptable comorbid conditions for
liver transplantation.
"The effect of anti-HCV therapy at the population level is likely to have a
much longer lag period compared with that for HBV, because the regimens
available to date are not uniformly effective, especially in patients with
advanced fibrosis and contraindicated, by and large, in those with
decompensated liver disease," the authors suggested.
In the case of hepatitis B, however, the parallel decrease in mortality
suggests a real decrease in the occurrence of ESLD.
"The evidence to link this trend to antiviral therapy [for HBV] is indirect
and circumstantial," they wrote, "however, there are few other plausible
explanations for this trend other than a widespread application of antiviral
therapy."
Division of Gastroenterology & Hepatology and Division of Biostatistics, Mayo
Clinic College of Medicine, Rochester, MN; University of California at San
Francisco, San Francisco, CA; United Network for Organ Sharing, Richmond, VA;
Gilead Sciences, Inc, Foster City, CA.
12/11/09

Reference
W Ray Kim, NA Terrault, RA Pedersen, and others. Trends in Waiting List
Registration for Liver Transplantation for Viral Hepatitis in the United
States. Gastroenterology 137(5): 1680-1686 (Abstract). November 2009.

手牵手

少病毒性肝炎患者的终末期肝病
Are Awaiting Liver Transplants,Likely Due to Effective Hepatitis B Treatment 正在等待肝移植，可能是由于B型肝炎的有效治疗

Fewer Viral Hepatitis Patients with End-stage Liver Disease Are Awaiting Liver少病毒性肝炎患者的终末期肝病患者在等待肝
Transplants, Likely Due to Effective Hepatitis B Treatment移植，可能是由于B型肝炎的有效治疗

SUMMARY: Trends over time in the number of patients registering for the摘要：对在为病人数目的登记时间趋势
liver transplant waiting list show a decrease in the proportion with end-stage肝脏移植轮候名单显示，这与最终的比例下降阶段
liver disease (ESLD), while the proportion with hepatocellular carcinoma (HCC)肝病（终末期肝病），而与肝细胞癌（HCC比例）
has increased, researchers reported in the November 2009 issue of有所增加，研究人员在2009年11月发行
Gastroenterology.胃肠病学。 The decline in ESLD was especially pronounced among patients在终末期肝病的跌幅尤其明显的患者
with hepatitis B, which the investigators attributed to widespread use of与B型肝炎，而飞机失事原因是由于广泛使用
effective antiviral therapy.有效的抗病毒治疗。


By Liz Highleyman由Liz Highleyman
Over years or decades, chronic hepatitis B virus (HBV) and hepatitis C virus过去几年或几十年，慢性乙型肝炎病毒（HBV）和丙型肝炎病毒
(HCV) infection can progress to advanced liver disease and are major reasons （HCV）感染可以发展为晚期肝癌患者，是主要原因
for liver transplants in the US Other indications include alcoholic在美国的其他适应症包括酒精肝移植
hepatitis and liver toxicity (for example, due to acetaminophen or poisonous肝炎和肝毒性（例如，由于对乙酰氨基酚或有毒
mushrooms).蘑菇）。
There has been significant progress in treating viral hepatitis over the past目前已在治疗病毒性肝炎对过去取得重大进展
decade, and infants are now routinely vaccinated against HBV (done as an 10年，现在通常婴儿注射预防乙型肝炎病毒（作为完成
adolescent if not received earlier).如果没有收到青少年更早）。 But many people with HBV or HCV have not但是，乙肝病毒或丙型肝炎病毒有很多人不
been diagnosed, and a significant number of those who received treatment do被诊断，以及对这些接受治疗的谁做大量
not achieve a sustained response, or "cure."无法实现持续的反应，或“治疗”。
W. Ray Kim from the Mayo Clinic College of Medicine and colleagues布什雷金从梅奥临床医学院和同事
investigated whether the widespread adoption of antiviral therapies for调查是否抗病毒治疗的广泛应用
hepatitis B and C has affected liver transplant waiting list registration,乙型肝炎和丙型肝炎，影响肝脏移植轮候册上登记，
analyzing longitudinal trends for patients with hepatitis B and C and those分析与乙型和丙型肝炎的病人和纵向趋势
with non-viral liver disease.与非病毒性肝脏疾病。
The researchers performed a retrospective analysis of registry data from all研究人员进行了一项回顾性的注册表数据分析从所有
US liver transplant centers, including all adult primary liver美国肝脏移植中心，包括所有成人原发性肝癌
transplantation candidates registered with the Organ Procurement and采购与器官移植的候选人和注册
Transplantation Network (OPTN) between 1985 and 2006.移植网络（OPTN）1985年至2006年。
Standardized incidence rates were calculated according to underlying disease标准化发病率的计算基础疾病
(HBV, HCV, and other) and indication for transplantation (fulminant liver （乙肝病毒，丙肝病毒和其他）和移植指示（暴发性肝
disease, ESLD, and HCC).病，终末期肝病和肝癌）。
Results结果
Out of 113,927 unique waiting list registrants, 4793 (4.2%) had HBV, 40,923出于113927独特的轮候册登记，4793（4.2％）有乙肝病毒，40923
(35.9%) had HCV, and the remaining 68,211 (59.9%) had neither virus. （35.9％）有丙型肝炎病毒，其余68211（59.9％），既没有病毒。
The 3 groups were similar in age, but patients with viral hepatitis 3组的年龄相似，但病人病毒性肝炎
(especially HBV) were more likely to be male. （尤其是HBV）的人更有可能是男性。
The rate of waiting list registrations for ESLD and fulminant liver disease在等待终末期肝病和暴发性肝疾病的名单登记率
decreased overall during the study period.降低整体在研究期间。
The decrease in registrations due to ESLD was most pronounced.在注册，由于终末期肝病的减少最为明显。
The decrease in registration for ESLD related to HCV was significantly larger在登记的有关丙型肝炎终末期肝病跌幅显着增大
than that for ESLD related to non-viral causes.比对终末期肝病相关的非病毒原因。
In contrast, there was a persistent increase in waiting list registrations与此相反，有一个在轮候册登记持续上升
for HCC.为肝癌。
The HCC increase was least dramatic among registrants with HBV.在肝癌增长幅度最小乙肝病毒之间的注册。
Based on these findings, the study authors concluded, "The pattern of liver基于这些发现，该研究的作者认为：“肝模式
transplantation waiting list registration among patients with hepatitis B等待移植中乙型肝炎患者名单上登记
suggests that the widespread application of oral antiviral therapy for HBV表明，口服的乙型肝炎抗病毒治疗的广泛应用
contributed to the decreased incidence of decompensated liver disease."促进了失代偿性疾病的发病率下降。“
In their discussion, the researchers offered evidence that the trends were not在他们的讨论中，研究人员提供的证据的趋势是没有
primarily attributable to changes in the organ allocation system (which tended主要是由于在器官分配制度的变化（这往往
to favor patients with HCC compared with other causes).对肝癌患者的青睐，相对于其他原因）。
They noted that another plausible explanation may be that a decreasing他们指出，另一个可能的解释，可能是减少的
proportion of patients are considered suitable candidates for liver的患者比例被认为是合适的候选人肝
transplants, rather than there being fewer people who develop ESLD.移植，而不是有被少谁开发终末期肝病的人。
In the case of hepatitis C, other epidemiological data do not suggest a在C型肝炎，案件的其他流行病学数据不建议1
decline in end-stage disease, so it may be that more HCV patients with ESLD下降终末期疾病，因此它可能是更多的丙型肝炎患者的终末期肝病
are considered to be too old or to have unacceptable comorbid conditions for被认为是太旧或有不能接受的共病情况
liver transplantation.肝移植。
"The effect of anti-HCV therapy at the population level is likely to have a他说：“反效果，丙型肝炎病毒在人群水平疗法可能有
much longer lag period compared with that for HBV, because the regimens更长的滞后期相比，对乙肝病毒，因为该疗法
available to date are not uniformly effective, especially in patients with可至今没有统一的效果，尤其是在患者，
advanced fibrosis and contraindicated, by and large, in those with先进的纤维化和禁忌，总的来说，在那些
decompensated liver disease," the authors suggested.失代偿性疾病“，作者建议。
In the case of hepatitis B, however, the parallel decrease in mortality在B型肝炎的情况，但是，同时减少死亡率
suggests a real decrease in the occurrence of ESLD.建议在真正的终末期肝病的发生减少。
"The evidence to link this trend to antiviral therapy [for HBV] is indirect说：“证据显示这种趋势乙型肝炎抗病毒治疗[]是间接的
and circumstantial," they wrote, "however, there are few other plausible和旁证，“他们写道，”但是，很少有其他可行的
explanations for this trend other than a widespread application of antiviral说明这种趋势不是一个普遍适用的其他抗病毒药
therapy."治疗。“
Division of Gastroenterology & Hepatology and Division of Biostatistics, Mayo司与肝脏胃肠病学和生物统计学，梅奥部
Clinic College of Medicine, Rochester, MN; University of California at San临床医学院，明尼苏达州罗切斯特，加州大学圣
Francisco, San Francisco, CA; United Network for Organ Sharing, Richmond, VA;旧金山，加州旧金山，美国器官共享网络，里士满，弗吉尼亚州;
Gilead Sciences, Inc, Foster City, CA.吉利德科学公司，加利福尼亚州福斯特城。
12/11/09 12/11/09

Reference参考
W Ray Kim, NA Terrault, RA Pedersen, and others.糯雷金，不适用Terrault，机关彼得森等。 Trends in Waiting List公屋轮候册趋势
Registration for Liver Transplantation for Viral Hepatitis in the United登记病毒性肝炎的肝移植在美国
States.国家。 Gastroenterology 137(5): 1680-1686 (Abstract).肠胃病137（5）：1680至1686年（摘要）。 November 2009. 2009年11月。

特深沉

目前已知的药物就可以将乙肝控制不会到肝衰竭的程度。肝硬化进程可以控制到不影响寿命的程度。
但肝癌比例还是比非携带者高。