Outcomes for patients with hepatitis B who need liver transplants

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Outcomes for patients with hepatitis B who need liver transplants

Survival rates are similar among patients with hepatitis B who are listed

for liver transplantation, whether or not they have hepatocellular carcinoma

(HCC), according to a new study in the March 2007 issue of Liver

Transplantation. An accompanying editorial suggests that these results

affirm the current policy on the allocation of donor livers.

The study and the editorial appear in the March 2007 issue of Liver

Transplantation, the official journal of the American Association for the

Study of Liver Diseases (AASLD) and the International Liver Transplantation

Society (ILTS). The journal is published on behalf of the societies by

Wiley & Sons, Inc. and is available online via Wiley InterScience at

http://www.interscience.wiley.com/journal/livertransplantation.

The United Network for Organ Sharing (UNOS) utilizes the Model for End-Stage

Liver Disease (MELD) to determine allocation of available organs. Patients

with hepatocellular carcinoma have higher MELD scores, and may be more

likely to receive transplants quickly compared to patients with other types

of liver disease. Without transplant, many HCC patients die or become

unsuitable for transplantation because of tumor progression.

Led by S. Lok, M.D. of the Division of Gastroenterology at the

University of Michigan, researchers set out to compare clinical outcomes for

hepatitis B patients awaiting a liver transplant, whether or not they had

HCC. They enrolled 279 patients from the National Institutes of

Health-sponsored HBV-OLT study between November 2001 and June 2005. Of these

patients 183 had HBV with cirrhosis, and 96 had HBV with HCC. Most were

receiving antiviral therapy. The researchers collected demographic and

laboratory data for all participants, and computed a MELD score for each.

They then followed the patients for a median of 30.2 months.

The patients with HBV-HCC were older, more likely to be Asian and had less

severe liver impairment than patients with HBV-cirrhosis; 78 percent

underwent liver transplantation, compared to 51 percent of patients with

HBV-cirrhosis. Despite this difference, 5-year survival rates were similar:

73 percent of the HBV-HCC group, compared to 78 percent of the HBV-cirrhosis

group. The 5-year survival rates for patients who did not receive a

transplant were also very similar: 82 percent of the HBV-HCC group versus 79

percent of the HBV-cirrhosis group. It should be noted that 71% of the

patients in the HBV-HCC group who had not been transplanted had received

some form of HCC treatment including surgical resection and the number of

patients alive without transplant 5 years after listing was very small

(n=6).

" Despite more advanced liver disease and a lower rate of transplantation,

intention-to-treat survival of patients listed for HBV-cirrhosis was

comparable to those with HBV-HCC, possibly related to beneficial effects of

antiviral therapy. However, these data may not apply to patients with liver

disease due to other etiologies for which safe and effective therapies that

can improve or stabilize liver disease in those with decompensated cirrhosis

are not available " the authors conclude.

In an accompanying editorial, Myron Schwartz and colleagues from the Mount

Sinai Liver Cancer Program at the Mount Sinai School of Medicine in New York

say the study vindicates UNOS policy while reporting a surprising finding:

survival without transplantation was excellent and equal between the two

groups, with 5-year survival in patients not transplanted actually better

than the survival for the entire cohort.

" This figure calls into question the basis for placing these patients on the

waiting list in the first place, " the authors write. Furthermore, since

previous studies have shown that 5-year survival for HCC patients without

treatment is unusual, " the accuracy of the diagnosis of HCC in these is

questionable, " they say.

The Wong study does show that UNOS policy helps patients with high MELD

scores get a liver transplant, and that their prioritization does not affect

outcomes for non-HCC patients with HBV. " The refinement of the UNOS

algorithm to optimally balance the risks for HCC and non-HCC liver

transplant candidates remains a work in progress, " conclude the

authors.- Wiley & Sons, Inc.

http://www.huliq.com/13231/outcomes-for-patients-with-hepatitis-b-who-need-liver\

-transplants

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