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Open Access 01-09-2009 | Introduction
Old and rising stars in the lymphoid liver
Published in: Seminars in Immunopathology | Issue 3/2009
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Regardless of the etiology or pathogenesis, chronic liver disease remains a major health issue worldwide and a significant cause of morbidity and mortality particularly when its common outcomes, i.e., liver cirrhosis and primary liver cancer, are observed. As a result, liver diseases cumulatively account for enormous costs, as well represented by health-state utilities and subsequent cost-utility analysis [1]. Table 1 illustrates the available data on disease prevalence, economic costs, and need for liver transplantation in the US. From a clinical standpoint, the majority of conditions remain asymptomatic until advanced stages are established. From a pathogenetic standpoint, all chronic liver diseases manifest one common trait, that is the involvement of the immune system, and over the past decade the role of the liver as a critical immunological center has been established thus overcoming the classical view of this organ as a mere target of the autoimmune or immune-mediated injury.
Table 1
Prevalence, yearly economic cost, and liver transplantation of adult and pediatric liver diseases in the US
|
Prevalence [47]
|
Expenditures (US$ million) [47]
|
Liver transplantations (% of total) [48]
|
|
|---|---|---|---|
|
Adult disease
|
|||
|
Alcoholic liver disease
|
7.4%
|
26,400
|
18%a
|
|
Non-alcoholic fatty liver disease
|
20%
|
–
|
11%b
|
|
Hepatitis C
|
1.8%
|
1,300
|
29%a
|
|
Hepatitis B
|
4.9%
|
–
|
2%
|
|
Primary biliary cirrhosis
|
0.04%
|
115
|
9%c
|
|
Primary sclerosing cholangitis
|
0.004%
|
–
|
–
|
|
Autoimmune hepatitis
|
2%
|
||
|
Hepatocellular carcinoma
|
0.004%
|
1,300
|
13%
|
|
Pediatric disease
|
|||
|
Biliary atresia
|
–
|
–
|
3%
|
|
Wilson disease
|
0.003%
|
–
|
–
|