By Liz Highleyman

Chronic viral hepatitis, which can lead to liver cirrhosis, hepatocellular carcinoma (HCC), and end-stage liver disease (ESLD), is a common indication for liver transplantation. However, shifts in the epidemiology and improvements in treatment of hepatitis B and hepatitis C over the years may have altered the rate of liver transplantation.

After noting that liver transplant physicians have anecdotally reported that fewer patients seem to require transplantation due to hepatitis B-related ESLD since the widespread application of effective antiviral agents active against HBV, researchers analyzed nationwide data on patients with HBV-related liver disease who were wait-listed for transplants in the U.S. Results were reported at the 58th Annual Meeting of the American Association for the Study of Liver Diseases in Boston (November 2-6, 2007).

All liver transplant candidates registered with the Organ Procurement and Transplantation Network between 1994 and 2006 were identified, and those whose primary diagnosis included hepatitis B and/or hepatitis C were included in the analysis.

Results

• There was a rapid increase in the number of waiting list registrants with hepatitis B and C in the 1990s.

• However, the number of registrants with hepatitis B peaked at 586 in 2000, followed by a 30% reduction over the ensuing 6 years to 409 in 2006.

• By contrast, the number of registrants with hepatitis C, which dipped in 2002 following implementation of the MELD system, returned to its previous level.

• Among hepatitis B patients, the proportion of registrants of Asian race/ethnicity increased from 12% to 35%, and those of African race from 5% to 15% between 1994 and 2006.

• The proportion of hepatitis B patients with HCC at the time of liver transplantation increased from 8% to 12% over the study period.

Conclusion

“The number of patients registered for liver transplantation in the U.S. for decompensated liver disease secondary to HBV decreased substantially since 2000, a trend not mirrored in HCV,” the researchers concluded. “Many other epidemiologic explanations for this trend are feasible, but widespread application of antiviral agents may have contributed to the decreased incidence of decompensated liver disease.”