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BOSTON – Research presented this week at The Liver Meeting® -- held by the American Association for the Study of Liver Diseases -- shows a recent plateau of chronic hepatitis B patients listed for liver transplantation, but a continued rise in liver cancer among these patients.
It is estimated that nearly 240 million people, worldwide, are affected by chronic hepatitis B (HBV) – a viral infection, spread through bodily fluids, that attacks the liver.
In recent years, antiviral therapies have provided new options for treating HBV, and many in healthcare expected their introduction to positively impact the rates of HBV-related liver cancer and decompensated liver disease -- a stage of advanced irreversible liver damage that requires liver transplantation.
To investigate this, researchers recently looked at the overall trends of patients registered onto liver transplantation waitlists, the number of people who survived while awaiting liver transplantation, and the likelihood of receiving transplantation among adults (18 and older) with chronic HBV in the United States.
“While currently available antiviral therapies for chronic HBV are successful in achieving viral suppression, a true cure that completely eradicates the virus from one’s body is rare,” explains Robert Wong, MD, MS; assistant clinical professor of medicine; director of research and education; Division of Gastroenterology and Hepatology at Alameda Health System – Highland Hospital, and lead investigator in the study. “Our current study aimed to better understand whether current treatments for chronic HBV actually impacted rates of HBV-related disease progression to the point of requiring liver transplantation, including HBV-related hepatocellular carcinoma (i.e., liver cancer). Understanding these trends is particularly important given the persistent imbalance in the number of patients requiring liver transplantation and number of donor livers available to be transplanted in the United States.”
Using data from the United Network for Organ Sharing registry, Dr. Wong’s team studied 6,797 patients with HBV -- among which 24.3 percent also had liver cancer – who were listed for liver transplantation during three different time periods: 1992-1996 (Era 1), 1997-2004 (Era 2) and 2005-2013 (Era 3).
The researchers found the total number of HBV patients listed for liver transplantation more than doubled from 907 in Era 1 to 2,844 in Era 2, and waitlist registrations plateaued to 3,046 in Era 3. Dr. Wong hypothesizes this plateau is due to the introduction of antiviral therapies in the treatment of the disease.
The team also noted an increase in the proportion of waitlisted patients with liver cancer from 5.4 percent in Era 1 to 39 percent in Era 3, and the majority of these patients were men. “These higher rates among men are interesting,” says Dr. Wong. “Overall, studies have shown that men have a higher risk for liver cancer compared to women. The reason for this isn’t entirely clear, but it may reflect higher risk of concurrent risk factors such as alcohol or tobacco use.”
The team also noted Asian patients on waitlists jumped from 24.2 percent in Era 1 to 50.4 percent in Era 3, and Asians accounted for 66.6 percent of waitlisted patients with liver cancer in Era 3. Dr. Wong notes that some studies have show genotypes found in Asia (i.e., B and C) may have greater risk for liver cancer, and he also notes that Asians with HBV might have greater access to care – making them more likely to be evaluated and listed for liver transplantation over other ethnic groups.
Finally, the number of patients who died while waiting for a liver transplantation significantly improved in later eras, and Dr. Wong’s team suspects this may reflect the effectiveness of antiviral therapies in delaying disease progression.
“While current therapies are effective in suppressing HBV and reducing risk of cirrhosis and hepatocellular carcinoma, our current study demonstrates that HBV-related hepatocellular carcinoma is still a major concern,” says Dr. Wong. “In addition to implementing effective screening of high-risk patients for chronic HBV so that appropriate early initiation of antiviral therapy can be started to delay disease progression, hepatocellular carcinoma screening and surveillance among HBV patients is equally important given that early diagnosis improves options for curative treatment. Future studies focusing on developing better prediction models for disease progression and development of hepatocellular carcinoma may help better risk stratify HBV patients into more aggressive treatment and liver cancer screening and surveillance programs. In addition, with the many potential HBV therapies on the horizon, it will be interesting to understand what treatment endpoints are most effective at reducing HBV disease progression and hepatocellular carcinoma (e.g. viral suppression, normalization of alanine aminotransferases and HBV surface antigen loss).”
The study entitled “Despite Plateauing of Chronic Hepatitis B Virus (HBV) Patients Listed for Liver Transplantation, the Proportion of Patients With HBV-Related Hepatocellular Carcinoma Continues to Rise” will be presented by Kellie Young, MD at John B. Hynes Veterans Memorial Convention Center in Boston on Monday, November 14 in Room 210 at 3pm. The corresponding abstract (number 211) can be found in the journal, Hepatology – Special Issue: The 67th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2016.
About the AASLD
AASLD is a medical subspecialty society representing clinicians and researchers in liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.
AASLD is the leading organization of scientists and healthcare professionals committed to preventing and curing liver disease. AASLD was founded in 1950 by a small group of leading liver specialists and has grown to an international society responsible for all aspects of hepatology.
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