NASH 成为女性肝移植首要原因：肝移植适应证的最新分析及种族和性别差异
NASH Leading Cause of Liver Transplant in Women: Updated Analysis of Indications For Liver Transplant and Ethnic and Gender Variances.
机构信息
Fatty Liver Program, Division of Digestive and Liver Diseases, Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Biostatistics & Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Department of Surgery, Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Texas Liver Institute, San Antonio, TX, USA. Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA. These authors contributed equally: Mazen Noureddin, Aarshi Vipani.
出版信息
Am J Gastroenterol. 2018 Nov;113(11):1649-1659. doi: 10.1038/s41395-018-0088-6. Epub 2018 Jun 8.
OBJECTIVES
Chronic infection with hepatitis C virus (HCV) was previously the leading indication for liver transplant (LT) in the United States. However, since 2014 the use of direct-acting antivirals (DAAs) has decreased the chronic HCV burden, while the prevalence of nonalcoholic steatohepatitis (NASH) has risen substantially through the last decade. Both gender and ethnic disparities in indications for LT have been shown in the past but no data on this have been reported since the implementation of DAAs.
METHODS
We assessed changes in etiologies for LT listing and in gender and ethnic differences in those listed for LT. Adult patients registered for LT in the United Network for Organ Sharing/Organ Procurement and Transplantation Network database between January 1, 2004 and December 31, 2016 were included. Multinomial logistic regression modeling was used to test for changes in waitlist or liver transplant rates.
RESULTS
The study included 127,164 adult patients registered for LT. By 2016, alcoholic liver disease (ALD) was the leading etiology for waitlisting and LT; NASH was second; hepatocellular carcinoma (HCC) due to chronic HCV and chronic HCV alone were 3rd and 4th. NASH was the leading cause for LT for women and the 2nd leading cause for men (following ALD). NASH increased as the cause in all ethnic subgroups and was the leading cause in 2016 among Asian, Hispanic, and non-Hispanic white females. We also found that although the indication for liver transplant for hepatocellular carcinoma (HCC) due to HCV has increased over the years, this indication decreased for the first time between 2015 and 2016 in both males and females.
CONCLUSIONS
NASH is currently the second leading cause for LT waitlist registration/liver transplantation overall, and in females, the leading cause. Given the rate of increase, NASH will likely rise to become the leading indication for LT in males as well.
目的
慢性丙型肝炎病毒（HCV）感染曾是美国肝移植（LT）的主要适应证。然而，自 2014 年以来，直接作用抗病毒药物（DAAs）的应用降低了慢性 HCV 负担，而在过去十年中，非酒精性脂肪性肝炎（NASH）的患病率大幅上升。过去已经显示出 LT 适应证中的性别和种族差异，但自 DAA 实施以来，尚无关于这方面的数据报告。
方法
我们评估了 LT 适应证的病因变化以及 LT 适应证中的性别和种族差异。纳入 2004 年 1 月 1 日至 2016 年 12 月 31 日期间在美国器官共享网络/器官获取和移植网络数据库中登记的成人 LT 患者。采用多项逻辑回归模型检验候补名单或肝移植率的变化。
结果
本研究共纳入 127164 名成人 LT 登记患者。到 2016 年，酒精性肝病（ALD）是等候名单和 LT 的主要病因；非酒精性脂肪性肝炎（NASH）是第二大病因；HCC 是由于慢性 HCV 和单独的慢性 HCV 引起的，分别排名第三和第四。NASH 是女性 LT 的主要原因，也是男性的第二大原因（仅次于 ALD）。NASH 在所有种族亚组中都是导致 LT 的主要原因，在 2016 年，亚裔、西班牙裔和非西班牙裔白种女性中 NASH 是主要原因。我们还发现，尽管 HCV 引起的 HCC 肝移植指征多年来有所增加，但 2015 年至 2016 年，男女的这一指征首次下降。
结论
NASH 目前是 LT 候补名单登记/肝移植的第二大总体适应证，在女性中，也是主要的适应证。鉴于其增长率，NASH 很可能上升为男性 LT 的主要适应证。
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