美国病毒性肝炎的肝移植中候诊单注册的趋势

liver411

Trends in waiting list registration for liver transplantation for viral hepatitis in the United States.
出处：Gastroenterology   2009  Nov  137(5) :1680-6
作者：Kim WR;Terrault NAedersen RA;Therneau TM;Edwards E;Hindman AA;Brosgart CL
PMID：19632234

背景与目的：过去十年中，在慢性肝炎相关的肝病治疗中取得了重大进展，特别乙型肝病毒（HBV）感染患者的治疗。为了调查抗病毒疗法在大人群的应用是否影响肝脏移植的候诊单注册，我们对乙型和丙型肝炎和非病毒性肝病患者进行候诊单注册的纵向趋势分析。
方法：本研究介绍了含有US肝移植中心注册数据的一项回顾性分析。在分析中包括1985年-2006年间在器官切取和移植网络中注册的全部成人（原发性肝移植候选者）。计算由隐晦的疾病（HBV和HCV感染和其它）和移植适应症（暴发性肝病，肝癌[HCC]和末期肝病[ESLD]）引起的肝移植的候诊单注册的标准化发病率。
结果：113927例独特候诊单注册者，4793例（4.2％）患者出现HBV，40923例（35.9％）患者出现HCV感染，其余的68211例（59.9％）患者既没有出现HBV也没有出现HCV感染。ESLD和暴发性肝病的候诊单注册发病率降低，而HCC的候诊单注册发病率增加。ESLD注册中降低的最为明显，而在患有乙型肝炎注册者中，HCC的增加为最小的。至少在中的登记终末期肝病继发丙型肝炎病毒感染也明显大于与非病毒病因终末期肝病患者登记急剧下降。
结论：在等待肝移植中的模式与乙型肝炎患者名单登记表明，口服的乙型肝炎抗病毒治疗的广泛应用导致了失代偿性疾病的发病率下降。

BACKGROUND & AIMS: In the last decade, significant progress has been made in the treatment of liver disease associated with chronic hepatitis, especially in patients infected with the hepatitis B virus (HBV). To investigate whether the population-wide application of antiviral therapies has impacted liver transplant waiting list registration, we analyzed longitudinal trends in waiting list registration for patients with hepatitis B and C and those with nonviral liver disease. METHODS: This study represented a retrospective analysis of registry data containing all US liver transplant centers. All adult, primary liver transplantation candidates registered to the Organ Procurement and Transplantation Network between 1985 and 2006 were included in the analysis. Standardized incidence rates were calculated for waiting list registration for liver transplantation by underlying disease (HBV and HCV infection and other) and by indication for transplantation (fulminant liver disease, hepatocellular carcinoma [HCC], and end-stage liver disease [ESLD]). RESULTS: Of 113,927 unique waiting list registrants, 4793 (4.2%) had HBV, and 40,923 (35.9%) had HCV infections; the remaining 68,211 (59.9%) had neither. The incidence of waiting list registration for ESLD and fulminant liver disease decreased, whereas that for HCC increased. The decrease in ESLD registration was most pronounced, and the increase in HCC was least dramatic among registrants with hepatitis B. The decrease in registration for ESLD secondary to HCV infection was also significantly larger than that for ESLD patients with nonviral etiologies. CONCLUSIONS: 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.

专家评价：
Didier Samuel
Groupe Hospitalier Paul Brousse, France
Gastroenterology & Hepatology
This paper evaluates the evolution of the indications for viral hepatitis in the waiting list for liver transplantation (LT) in the USA from 1995 to 2006. Overall, 4.2% had hepatitis B virus (HBV) and 35.9% had hepatitis C virus (HCV). Among HBV patients, there was a dramatic decrease in the indications of LT for end-stage liver disease (ESLD) and fulminant hepatitis and a dramatic increase for hepatocellular carcinoma (HCC). Among HCV cases, there was a decrease in the indications of LT for ESLD and an increase for HCC. These trends were not observed in non-viral liver diseases.Viral hepatitis was the first indication of LT. Dramatic improvements in the results of LT for HBV have been observed with the advent of effective prophylactic methods against HBV recurrence. Effective antiviral anti-HBV agents may have reduced the indications for LT. HCV was the first indication for LT; however, HCV recurrence post-LT remains an unsolved issue. The decrease in the indication of LT for ESLD in HBV patients could be the consequence of a modification in the criteria for LT and also of the advent of effective antiviral therapy. However, there is, in parallel, a dramatic increase in HCC as an indication for LT. In HCV patients the increase in HCC might be the consequence of the longer period after infection with HCV. Whatever the causes, there is clearly an increase in HCC as an indication for LT in viral disease while it is not yet observed in non-viral disease. The causes for this evolution in the indicating factors for LT need to be explored.



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