Department of Molecular Medicine, University of Padua, Padova, Italy.
Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy.
Infect Dis (Lond). 2020 Aug;52(8):557-562. doi: 10.1080/23744235.2020.1763453. Epub 2020 May 13.
The indications to LT are changing rapidly in Europe and the U.S. mainly due to the extensive use of direct-acting antiviral agents (DAA) against HCV. Italy was an endemic area for viral hepatitis. The study reviewed liver transplant registry of a leading Italian centre from the year 2014 (the year before the extensive use of DAA in Italy) to December 2018, with the scope of recording trends in indications. The indications were categorised as: HCV; HBV ± HDV; alcohol-dependent liver disease (ALD); NASH; mescellaneous. Transplants for decompensation or hepatocellular carcinoma were analysed separately. The data were analysed using standard statistical methods. During the study period 463 LTs were accomplished. For the scope of the present study second transplants and transplant in patients <18 years were eliminated; in all, 397 patients were analysed. Overall, HCV infection was the main aetiological factor leading to transplant (139/397, 35%) followed by alcohol use (20.9%), HBV ± HDV (15.8%) and NASH (12.8%). In the decompensation group HCV decreased from 41.9% in 2014 to 14.3% in 2018 while alcohol increased ( < .001); in the HCC group, HCV decreased from 52.6% to 34% and alcohol and NASH increased; the number and proportion of HBV infections remained stable over time, with a 56% prevalence of HDV among decompensated patients. LT landscape is rapidly evolving; hepatitis virus infections still maintain a remarkable proportion among the indications for LT in an area that reached in the past high endemic levels for hepatitis C and B.
LT 的适应证在欧洲和美国正在迅速变化，主要是由于直接作用抗病毒药物（DAA）在 HCV 中的广泛应用。意大利是病毒性肝炎的流行地区。该研究回顾了意大利一家领先的意大利中心的肝移植登记处从 2014 年（DAA 在意大利广泛使用的前一年）到 2018 年 12 月的数据，目的是记录适应证的趋势。适应证分为：HCV；HBV±HDV；酒精性肝病（ALD）；NASH；混合。对代偿失调或肝细胞癌的移植分别进行了分析。使用标准统计方法分析数据。在研究期间完成了 463 例 LT。就本研究的范围而言，排除了第二次移植和 18 岁以下患者的移植；共分析了 397 例患者。总的来说，HCV 感染是导致移植的主要病因（139/397，35%），其次是酒精使用（20.9%）、HBV±HDV（15.8%）和 NASH（12.8%）。在代偿失调组中，HCV 从 2014 年的 41.9%降至 2018 年的 14.3%，而酒精增加（<0.001）；在 HCC 组中，HCV 从 52.6%降至 34%，酒精和 NASH 增加；HBV 感染的数量和比例随时间保持稳定，代偿失调患者中 HDV 的患病率为 56%。LT 格局正在迅速发展；在过去丙型和乙型肝炎高发的地区，肝炎病毒感染在 LT 的适应证中仍然占有显著比例。
