Liver Transplantation for Hepatitis D Virus in the United States: A UNOS Study on Outcomes in the MELD Era

Kushner, Tatyana; Da, Ben L.; Chan, Aryana; Dieterich, Douglas T.; Sigel, Keith; Saberi, Behnam

doi:10.1097/txd.0000000000001253

Cited by 11 publications

(16 citation statements)

References 41 publications

(49 reference statements)

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“…Multiple prior studies have showed an increased morbidity and mortality associated with chronic hepatitis D virus infection 2–4 . We similarly noticed a statistically significant increase in need for liver transplantation among the HDV+ group.…”

Section: Discussionsupporting

confidence: 76%

“…This infection can either be concurrent coinfection with HBV or superinfection in a patient with chronic hepatitis B (CHB) 1 . Chronic HDV infection is the most severe form of chronic viral hepatitis and is associated with increased progression to liver cirrhosis, hepatocellular carcinoma (HCC), mortality from liver failure, and the need for liver transplant (LT) 2–4 . Despite its discovery almost 45 years ago in 1977 by Rizzetto et al, 5 the global burden of HDV infection remains poorly defined.…”

Section: Introductionmentioning

confidence: 99%

“…1 Chronic HDV infection is the most severe form of chronic viral hepatitis and is associated with increased progression to liver cirrhosis, hepatocellular carcinoma (HCC), mortality from liver failure, and the need for liver transplant (LT). [2][3][4] Despite its discovery almost 45 years ago in 1977 by Rizzetto et al, 5 the global burden of HDV infection remains poorly defined. A recent study estimated the prevalence of HDV seropositivity to be about 4.5% in hepatitis B surface antigen (HBsAg)-positive patients.…”

Section: Introductionmentioning

confidence: 99%

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The Delta Delta: Gaps in screening and patient assessment for hepatitis D virus infection

Nathani

Leibowitz

Giri

et al. 2022

Journal of Viral Hepatitis

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Hepatitis D virus (HDV) infection is highly prevalent in patients with chronic hepatitis B (CHB). AASLD guidelines recommend a risk-based screening approach. Our aim was to ascertain if the risk-based approach leads to appropriate HDV screening, identify targets to improve screening rates, and study HDV clinical burden. CHB patients screened for HDV from 01/2016 to 12/2021 were identified. Level of training and specialty of providers ordering HDV screening tests were determined. HDV seropositive (HDV+) patient charts were reviewed for the presence of individual risk factors per the AASLD guidelines to determine if they met screening criteria. The severity of liver disease at the time of HDV screening was compared between the HDV+ group and a matched (based on age, hepatitis B e antigen status, BMI and sex) HDV seronegative (HDV−) group. During the study period, 1444/11,190 CHB patients were screened for HDV. Most screening tests were ordered by gastroenterology (90.2%) specialists and attending physicians (80.5%). HDV+ rate was 88/1444 (6%), and 72 HDV+ patients had complete information for analysis. 18% of HDV+ patients would be missed by a risk-based screening approach due to unreported or negative risk factors (see Table ). A significantly higher number of HDV+ patients had developed significant fibrosis (p = 0.001) and cirrhosis (p < 0.01) by the time of screening than HDV− (n = 67) patients. In conclusion, targeted interventions are needed towards trainees and primary care clinics to improve screening rates. Current risk-based criteria do not appropriately screen for HDV. It is time for universal screening of HDV in CHB patients.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Delta Delta: Gaps in screening and patient assessment for hepatitis D virus infection

Nathani

Leibowitz

Giri

et al. 2022

Journal of Viral Hepatitis

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“…9 Because of the accelerated clinical course, patients with HDV cirrhosis are younger than HBV and HCV cirrhotics and run faster into decompensation 10 ; death is usually caused by liver failure rather than hepatocellular carcinoma (HCC), which may have no time to develop for the rapid progression of HDV disease. These clinical features were confirmed in a recent report of 152 HDV transplants performed in the United States in the years 2002–2019 11 ; the patients were younger than HBV transplants, often coinfected with the HCV, and likely to be listed for decompensated liver disease rather than for HCC.…”

Section: Introductionsupporting

confidence: 59%

“…54 The disproportionate number of HDV to HBV LTs against the minimal epidemiologic burden of HDV in Europe presumably results from the use of HBV antivirals that have afforded effective control of chronic hepatitis B, in contrast to the poor efficacy of interferon therapy used for CHD, which could not prevent progression of the disease to end-stage cirrhosis. In analogy with the American experience, 11 in Turin in the last decade, 62.3% of the HDV patients were transplanted for liver failure and 37.7% for HCC, whereas only 29.5% of the HBV patients were transplanted for liver failure and 70.5% for HCC, the development of which could not be prevented by antiviral therapy (Table 2).…”

Section: The Futurementioning

confidence: 98%

Liver Transplantation in Hepatitis B/Hepatitis D (Delta) Virus Coinfected Recipients

et al. 2022

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Hepatitis D is caused by the hepatitis D virus (HDV); it is the most severe form of viral hepatitis in humans, running an accelerated course to cirrhosis. There is no efficacious therapy, and liver transplantation provides the only therapeutic option for terminal HDV disease. However, HDV infection is prevalent in poor countries of the world with no access to liver transplant programs; liver grafting has been performed in high-income countries, where the prevalence of the infection has much diminished as a secondary effect of hepatitis B virus vaccination, and the demand for liver transplantation outlives in aging cirrhotics who acquired hepatitis D decades ago. This review describes the evolution of liver transplantation for HDV disease from its inception in 1987 to the present time, with an outlook to its future. It reports the progress in the prophylaxis of HDV reinfections to the success of the current standard of indefinite combination of hepatitis B virus antivirals with immunoglobulins against the hepatitis B surface antigen; however, the unique biology of the virus provides a rationale to reducing costs by limiting the administration of the immunoglobulins against the hepatitis B surface antigen.

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Management of chronic HBV‐HDV patients chronic HBV‐HDV infection: A review on new management options

Buti,

Gonzalez,

Riveiro‐Barciela

et al. 2023

UEG Journal

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Hepatitis D virus was first described by Mario Rizzeto in 1977, and it is considered chronic viral hepatitis with the poorest prognosis. Despite its discovery almost 50 years ago, progress in its diagnosis and treatment has been scarce until recent years. The approval of bulevirtide has shed some light for patients with Chronic Hepatitis D, although important gaps regarding its use in therapy as well as about the epidemiology and diagnosis of the disease need to be addressed.

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Liver Transplantation for Hepatitis D Virus in the United States: A UNOS Study on Outcomes in the MELD Era

Abstract: Supplemental Digital Content is available in the text.

Cited by 11 publications

References 41 publications

The Delta Delta: Gaps in screening and patient assessment for hepatitis D virus infection

The Delta Delta: Gaps in screening and patient assessment for hepatitis D virus infection

Liver Transplantation in Hepatitis B/Hepatitis D (Delta) Virus Coinfected Recipients

Management of chronic HBV‐HDV patients chronic HBV‐HDV infection: A review on new management options

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