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Nationwide decrease in the need for Liver transplant

Newswise — A new Mayo Clinic study found a nationwide decrease in the need for liver transplant in patients with hepatitis B, which coincides with the increasingly widespread use of oral antiviral medications to slow disease progression. The study will be presented this week at the annual meeting of the American Association for the Study of Liver Diseases in Boston.

Hepatitis B is a virus which infects the liver and causes it to become inflamed, which interferes with the liver's ability to function. The result can lead to liver failure, liver cancer or cirrhosis — a condition that causes permanent scarring of the liver. Each year approximately 6,000 liver transplants are performed in the United States; about 4 percent of liver transplant recipients have hepatitis B.

In the past, injections of interferon, a natural protein that inhibits the virus from replicating, was the most commonly used treatment for hepatitis B. Since 1996, four oral antiviral medications have been approved by the Food and Drug Administration for treatment of hepatitis B: lamivudine, adefovir dipivoxil, entecavir and telbivudine.

While none of the treatments for hepatitis B ‘cure’ the disease, medications can stop or reverse its progression,” says Ray Kim, M.D., a Mayo Clinic hepatologist and lead author of the study. “With the widespread application of the antiviral medications in the past 10 years, physicians have anecdotally noticed that fewer hepatitis B patients seem to need liver transplants.”

Dr. Kim and a team of researchers set out to determine if this was indeed the case. The team analyzed nationwide data on patients with hepatitis B, hepatitis C, or both hepatitis B and C, who were registered with the Organ Procurement and Transplantation Network for liver transplant between 1994 and 2006. The researchers found a rapid increase in the number of liver transplant registrants with hepatitis B and hepatitis C in the 1990s. However, the number of registrants with hepatitis B peaked in 2000 at 586 and then declined by 30 percent over the next six years to 409 in 2006. This trend was not mirrored with hepatitis C patients registered for liver transplant, where numbers dipped from 4,068 to 3,585 in 2002 and then regained the previous levels from 2003 to 2006.

“It is promising that on a nationwide, ‘big picture’ level, there is a demonstrable decrease in the need for liver transplants in these patients, which may be related to the use of antiviral medications for hepatitis B,” says Dr. Kim. “We plan to continue to look at the trends for both hepatitis B and hepatitis C over the next five years.”

More than 400 patients receive liver transplants at Mayo Clinic’s campuses in Minnesota, Florida and Arizona each year. Mayo Clinic is one of the most experienced liver transplant centers in the nation, with some of the highest survival rates in the world. For more information about liver transplant at Mayo Clinic, visit http://www.mayoclinic.org/liver-transplant/.