Kim W Ray, Terrault Norah A, Pedersen Rachel A, Therneau Terry M, Edwards Erick, Hindman Andrew A, Brosgart Carol L
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Gastroenterology. 2009 Nov;137(5):1680-6. doi: 10.1053/j.gastro.2009.07.047. Epub 2009 Jul 24.
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.
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]).
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.
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.
在过去十年中，慢性肝炎相关肝病的治疗取得了显著进展，尤其是在乙型肝炎病毒（HBV）感染患者中。为了研究抗病毒疗法在全人群中的应用是否影响了肝移植等待名单登记情况，我们分析了乙型和丙型肝炎患者以及非病毒性肝病患者等待名单登记的纵向趋势。
本研究是对包含所有美国肝移植中心的登记数据进行的回顾性分析。分析纳入了1985年至2006年间在器官获取与移植网络登记的所有成年原发性肝移植候选人。按潜在疾病（HBV和HCV感染及其他）和移植指征（暴发性肝病、肝细胞癌[HCC]和终末期肝病[ESLD]）计算肝移植等待名单登记的标准化发病率。
在113,927名独特的等待名单登记者中，4793人（4.2%）感染HBV，40,923人（35.9%）感染HCV；其余68,211人（59.9%）两者均未感染。ESLD和暴发性肝病的等待名单登记发病率下降，而HCC的发病率上升。ESLD登记的下降最为明显，在HBV感染者中HCC的上升最为不显著。HCV感染继发的ESLD登记下降也明显大于非病毒性病因的ESLD患者。
乙型肝炎患者肝移植等待名单登记模式表明，口服抗病毒疗法在HBV中的广泛应用导致了失代偿性肝病发病率的下降。
