Department of Surgery Science, University of Rome Tor Vergata, U.O.C. HepatoBiliary and Transplantation, Policlinico Tor Vergata, Rome, Italy.
Italian National Transplant Centre, National Institute of Health, Rome, Italy.
Dig Liver Dis. 2022 Dec;54(12):1664-1671. doi: 10.1016/j.dld.2022.08.033. Epub 2022 Sep 10.
Over the last decades relevant epidemiological changes of liver diseases have occurred, together with greatly improved treatment opportunities.
To investigate how the indications for elective adult liver transplantation and the underlying disease etiologies have evolved in Italy.
We recruited from the National Transplant Registry a cohort comprising 17,317 adults patients waitlisted for primary liver transplantation from January-2004 to December-2020. Patients were divided into three Eras:1(2004-2011),2(2012-2014) and 3(2015-2020).
Waitlistings for cirrhosis decreased from 65.9% in Era 1 to 46.1% in Era 3, while those for HCC increased from 28.7% to 48.7%. Comparing Eras 1 and 3, waitlistings for HCV-related cirrhosis decreased from 35.9% to 12.1%, yet those for HCV-related HCC increased from 8.5% to 26.7%. Waitlistings for HBV-related cirrhosis remained almost unchanged (13.2% and 12.4%), while those for HBV-related HCC increased from 4.0% to 11.6%. ALD-related cirrhosis decreased from 16.9% to 12.9% while ALD-related HCC increased from 1.9% to 3.9%.
A sharp increase in liver transplant waitlisting for HCC and a concomitant decrease of waitlisting for cirrhosis have occurred In Italy. Despite HCV infection has noticeably decreased, still remains the primary etiology of waitlisting for HCC, while ALD and HBV represent the main causes for cirrhosis.
过去几十年，肝脏疾病的相关流行病学发生了变化，同时治疗机会也大大改善。
调查意大利成人肝移植的适应证和潜在疾病病因的演变情况。
我们从国家移植登记处招募了一个队列，该队列包括 17317 名成年患者，他们于 2004 年 1 月至 2020 年 12 月期间等待原发性肝移植。患者分为三个时期：1（2004-2011 年）、2（2012-2014 年）和 3（2015-2020 年）。
肝硬化的候补名单从第 1 期的 65.9%下降到第 3 期的 46.1%，而 HCC 的候补名单从 28.7%增加到 48.7%。与第 1 期和第 3 期相比，HCV 相关肝硬化的候补名单从 35.9%下降到 12.1%，而 HCV 相关 HCC 的候补名单从 8.5%增加到 26.7%。HBV 相关肝硬化的候补名单几乎保持不变（13.2%和 12.4%），而 HBV 相关 HCC 的候补名单从 4.0%增加到 11.6%。ALD 相关肝硬化从 16.9%下降到 12.9%，而 ALD 相关 HCC 从 1.9%增加到 3.9%。
意大利的 HCC 肝移植候补名单急剧增加，而肝硬化的候补名单则相应减少。尽管 HCV 感染明显减少，但它仍然是 HCC 候补名单的主要病因，而 ALD 和 HBV 则是肝硬化的主要原因。
