Ivanics Tommy, Shwaartz Chaya, Claasen Marco P A W, Patel Madhukar S, Yoon Peter, Raschzok Nathanael, Wallace David, Muaddi Hala, Murillo Perez Carla Fiorella, Hansen Bettina E, Selzner Nazia, Sapisochin Gonzalo
Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Department of Surgery, Henry Ford Hospital, Detroit, MI, USA.
Transpl Int. 2021 Aug;34(8):1444-1454. doi: 10.1111/tri.13903. Epub 2021 Jul 7.
The liver transplantation (LT) landscape is continuously evolving. We sought to evaluate trends in indications for LT in Canada and the impact of primary liver disease on post-LT outcomes using a national transplant registry. Adult patients who underwent a primary LT between 2000 and 2018 were retrospectively identified in the Canadian Organ Replacement Registry. Outcomes included post-LT patient and graft survival. A total of 5,722 LTs were identified. The number of LT per year increased from 251 in 2000 to 349 in 2018. The proportion of patients transplanted for HCV decreased from 31.5% in 2000 to 3.4% in 2018. In contrast, the percentage of transplants for HCC increased from 2.3% in 2000 to 32.4% in 2018, and those performed for NASH increased from 0.4% in 2005 to 12.6% in 2018. Year of transplant (per 1 year) was protective for both patient (HR:0.96,95%CI:0.94-0.97; P < 0.001) and graft survival (HR:0.97, 95%CI: 0.96-0.99; P = 0.001). Post-LT outcomes have improved over time in this nationwide analysis spanning 18 years. Moreover, trends in the indications for LT have changed, with HCC becoming the leading etiology. The decrease in the proportion of HCV patients and increase in those with NASH has implications on the evolving management of LT patients.
肝移植（LT）领域在不断发展。我们试图利用全国移植登记处评估加拿大LT适应证的趋势以及原发性肝病对LT术后结局的影响。在加拿大器官替代登记处回顾性识别2000年至2018年间接受初次LT的成年患者。结局包括LT术后患者和移植物存活情况。共识别出5722例LT。每年的LT数量从2000年的251例增加到2018年的349例。因丙型肝炎病毒（HCV）接受移植的患者比例从2000年的31.5%降至2018年的3.4%。相比之下，因肝细胞癌（HCC）进行移植的比例从2000年的2.3%增至2018年的32.4%，因非酒精性脂肪性肝炎（NASH）进行移植的比例从2005年的0.4%增至2018年的12.6%。移植年份（每1年）对患者（风险比：0.96，95%置信区间：0.94 - 0.97；P < 0.001）和移植物存活（风险比：0.97，95%置信区间：0.96 - 0.99；P = 0.001）均具有保护作用。在这项长达18年的全国性分析中，LT术后结局随时间推移有所改善。此外，LT适应证的趋势已经改变，HCC成为主要病因。HCV患者比例的下降和NASH患者比例的增加对LT患者不断演变的管理具有影响。
