非酒精性脂肪性肝炎：印度肝脏移植中迅速增加的适应症。
Nonalcoholic Steatohepatitis: A Rapidly Increasing Indication for Liver Transplantation in India.
作者信息
Jothimani Dinesh, Danielraj Silas, Narasimhan Gomathy, Kaliamoorthy Ilankumaran, Rajakumar Akila, Palaniappan Kumar, Palanichamy Swetha, Rammohan Ashwin, Ramachandran Hemalatha, Rajalingam Rajesh, Rela Mohamed
机构信息
Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, Chromepet, Chennai, Tamilnadu, 600044, India.
出版信息
J Clin Exp Hepatol. 2022 May-Jun;12(3):908-916. doi: 10.1016/j.jceh.2021.09.017. Epub 2021 Sep 25.
BACKGROUND AND AIMS
Recently, there has been a considerable increase in patients with nonalcoholic fatty liver disease. Availability of high-efficacy drugs for hepatitis B and hepatitis C virus (HCV) infection may have changed the disease prevalence. We aimed to study the impact of this changing epidemiology in patients undergoing liver transplantation (LT) over a 10-year period.
METHODS
The study population was stratified into Period 1 (2009-2014) and Period 2 (2015-2019). Demographics, indications for LT and changes in the epidemiology between two periods were analysed. Aetiology-based posttransplant survival analysis was carried out.
RESULTS
Indication for LT among 1017 adult patients (277 in Period 1 and 740 in Period 2) showed a significant increase in nonalcoholic steatohepatitis (NASH; 85 [30.7%] and 311 [42%]; = 0.001), decrease in hepatitis C (49 [17.7%] and 75 [10.1%]; = 0.002), and increase in hepatocellular carcinoma from Period 1 to Period 2 (13 [26.5%] to 38 [50.7%]; = 0.009) among HCV patients. Patients transplanted for NASH had a lower 5-year survival compared with viral hepatitis (75.9% vs 87.4%; = 0.03). There was a strong association between coronary artery disease and NASH (hazard ratio = 1.963, 95% confidence interval, 1.19-3.22).
CONCLUSION
NASH is the leading indication for liver transplantation in India, surpassing viral hepatitis in recent years.
背景与目的
近年来，非酒精性脂肪性肝病患者数量显著增加。高效抗乙型肝炎和丙型肝炎病毒（HCV）感染药物的应用可能改变了疾病的流行情况。我们旨在研究这一流行病学变化对接受肝移植（LT）患者在10年期间的影响。
方法
研究人群分为第1期（2009 - 2014年）和第2期（2015 - 2019年）。分析了两期的人口统计学、肝移植指征及流行病学变化。进行了基于病因的移植后生存分析。
结果
1017例成年患者（第1期277例，第2期740例）的肝移植指征显示，非酒精性脂肪性肝炎（NASH）显著增加（85例[30.7%]和311例[42%]；P = 0.001），丙型肝炎减少（49例[17.7%]和75例[10.1%]；P = 0.002），HCV患者中肝细胞癌从第1期到第2期增加（13例[26.5%]至38例[50.7%]；P = 0.009）。因NASH接受移植的患者5年生存率低于病毒性肝炎患者（75.9%对87.4%；P = 0.03）。冠状动脉疾病与NASH之间存在强关联（风险比 = 1.963，95%置信区间，1.19 - 3.22）。
结论
在印度，NASH是肝移植的主要指征，近年来已超过病毒性肝炎。
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