Published: Nov 4, 2013
By Michael Smith, North American Correspondent, MedPage Today
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
WASHINGTON -- An increasing number of patients on liver transplant waiting lists have hepatitis C (HCV), researchers found.
But the increase is almost entirely due to an increasing number of HCV patients wait-listed for transplant because of hepatocellular cancer (HCC), according to Jennifer Flemming, MD, of Queen's University in Kingston, Ont.
The proportion of wait-listed patients whose viral infection led to end-stage liver disease (ESLD) remained roughly stable over an 8-year period ending in 2010, Flemming reported at the annual meeting of the American Association for the Study of Liver Diseases.
The trend is likely to continue, Flemming concluded, and could "further strain our already limited donor pool."
An important element in the changes over time is the Model for End-stage Liver Disease (MELD), which is used by the United Network of Organ Sharing to allocate organs, Flemming said. The model is based mainly on the degree of hepatic decompensation but has been modified to give patients with liver cancer a higher priority than they would otherwise get.
Flemming and colleagues looked at data from the Scientific Registry of Transplant Recipients for January 2003 through December 2010 to estimate longitudinal trends in liver transplantation secondary to HCV.
The issue is important, because the prevalence of HCV-related cirrhosis is rising and is expected to peak in 2020 at about a million Americans, she said. At the same time, the prevalence of ESLD and HCC is also expected to peak in 2020 at 150,000 and 14,000 patients, respectively.
Over the 8 years of the study, Flemming said, 20,325 HCV patients were wait-listed for transplant, including 12,724 with ESLD and 7,061 with HCC.
The yearly totals rose steadily from 2,074 in 2003 to 3,053 in 2020. But the number of those with ESLD only rose from 1,451 to 1,674, while the numbers with HCC more than doubled, from 623 in 2003 to 1,379 in 2010.
Compared with the general population, she said, the overall rate rose from 6.9 to 10.2 wait-listed patients per 100,000 and the rate for those with ESLD went from 4.8 to 5.6 per 100,000.
On the other hand, the rate for patients with HCC rose from 2.1 to 4.6 per 100,000.
In other words, Flemming said, the overall rise is "all due to the increased listing of patients with hepatocellular carcinoma."
Overall, the yearly increase was 4.7% and was statistically significant at P<0.001, while the yearly increase for ESLD was 0.7% and did not reach significance.
The yearly increase for HCC was 11.8% and was again significant at P<0.001.
Physicians involved with liver transplantation have noticed they are transplanting more HCV patients with cancer, commented Kenneth Chavin, MD, PhD, of the Medical University of South Carolina in Charleston, who was not part of the study but who moderated the session at which it was presented.
"But this is a very well-done study that confirms what we're seeing," Chavin told MedPage Today.
He added that there is active consideration to changing the rules for transplant to redress the imbalance. And, he said, the advent of new, more effective treatments for HCV might also change the pattern.