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. 2009 Nov;137(5):1680-6.
doi: 10.1053/j.gastro.2009.07.047. Epub 2009 Jul 24.

Trends in waiting list registration for liver transplantation for viral hepatitis in the United States

W Ray Kim  1 , Norah A Terrault, Rachel A Pedersen, Terry M Therneau, Erick Edwards, Andrew A Hindman, Carol L Brosgart
Affiliations

Trends in waiting list registration for liver transplantation for viral hepatitis in the United States

W Ray Kim et al. Gastroenterology. 2009 Nov.

Abstract

Background & aims: In the last decade, significant progress has been made in the treatment of liver disease associated with chronic hepatitis, especially in patients infected with the hepatitis B virus (HBV). To investigate whether the population-wide application of antiviral therapies has impacted liver transplant waiting list registration, we analyzed longitudinal trends in waiting list registration for patients with hepatitis B and C and those with nonviral liver disease.

Methods: This study represented a retrospective analysis of registry data containing all US liver transplant centers. All adult, primary liver transplantation candidates registered to the Organ Procurement and Transplantation Network between 1985 and 2006 were included in the analysis. Standardized incidence rates were calculated for waiting list registration for liver transplantation by underlying disease (HBV and HCV infection and other) and by indication for transplantation (fulminant liver disease, hepatocellular carcinoma [HCC], and end-stage liver disease [ESLD]).

Results: Of 113,927 unique waiting list registrants, 4793 (4.2%) had HBV, and 40,923 (35.9%) had HCV infections; the remaining 68,211 (59.9%) had neither. The incidence of waiting list registration for ESLD and fulminant liver disease decreased, whereas that for HCC increased. The decrease in ESLD registration was most pronounced, and the increase in HCC was least dramatic among registrants with hepatitis B. The decrease in registration for ESLD secondary to HCV infection was also significantly larger than that for ESLD patients with nonviral etiologies.

Conclusions: The pattern of liver transplantation waiting list registration among patients with hepatitis B suggests that the widespread application of oral antiviral therapy for HBV contributed to the decreased incidence of decompensated liver disease.

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Conflict of interest statement

Conflicts of interest

The authors disclose the following: W. Ray Kim received a grant from the Gilead Sciences, Inc, to conduct this study. He has served as a consultant for Roche, Bristol–Myers–Squibb, Idenix, Schering-Plough, and Gilead Sciences. Norah Terrault has received grants from Gilead Sciences, Cangene, NABI, and Roche and consulted Bristol-Myers-Squibb. Andrew Hindman was a former employee of Gilead Sciences, Inc, and Carol Brosgart was a former employee of Gilead Sciences. Terry Therneau, Rachel Pedersen, and Erick Edwards disclose no conflicts.

Figures

Figure 1
Figure 1
Total number of waiting list registrants (bars) and age-, gender-, and race-adjusted incidence rate of waiting list registration between 1985 and 2006.
Figure 2
Figure 2
Incidence rates for waiting list registration: (A) for HBV, (B) HCV, and (C) other diagnosis.
Figure 3
Figure 3
Mean MELD scores at the time of waiting list registration.
See this image and copyright information in PMC

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