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. 2020 Jan-Feb;10(1):30-36.
doi: 10.1016/j.jceh.2019.06.007. Epub 2019 Jul 10.

Nonalcoholic Steatohepatitis Becomes the Leading Indication for Liver Transplant Registrants Among US Adults Born Between 1945 and 1965

Farah Shirazi  1 , Jennifer Wang  1 , Robert J Wong  2
Affiliations

Nonalcoholic Steatohepatitis Becomes the Leading Indication for Liver Transplant Registrants Among US Adults Born Between 1945 and 1965

Farah Shirazi et al. J Clin Exp Hepatol. 2020 Jan-Feb.

Abstract

Background: Improved efforts in screening and treating chronic hepatitis C virus (HCV) infection are expected to reduce its burden among adults on the liver transplantation (LT) waitlist (WL). We aim to evaluate birth cohort-specific liver disease etiology trends in US adults listed for and receiving LT.

Methods: We evaluated 2005-2016 United Network for Organ Sharing LT registry data to evaluate birth cohort-specific trends in LT WL registrants and recipients in the US. Annual trends in etiology of liver disease at listing were compared between the 1945-1965 birth cohort and the non-1945-1965 birth cohort, were stratified by presence of hepatocellular carcinoma (HCC vs. non-HCC), and were focused on the four leading indications for LT in the US, nonalcoholic steatohepatitis (NASH), HCV infection, alcoholic liver disease (ALD), and those with combined alcoholic cirrhosis with HCV (HCV/ALD).

Results: From 2005 to 2016, although HCV infection was a leading indication for LT WL registration among the 1945-1965 birth cohort patients until 2015, NASH overtook HCV infection as the leading indication in 2016. When stratified by HCC status, both ALD and NASH surpassed HCV infection as the leading indication among 1945-1965 birth cohort WL registrants without HCC, whereas HCV infection remained the leading indication among patients with HCC. When evaluating trends in patients who received LT, HCV infection remained the leading indication among the 1945-1965 birth cohort patients.

Conclusion: In 2016, NASH surpassed HCV infection as the leading indication for WL registration among the 1945-1965 birth cohort patients. Improved HCV screening, increased availability of effective HCV infection treatment, and rising prevalence of nonalcoholic fatty liver disease may explain changes in LT indication among this group.

Keywords: ALD, alcoholic liver disease; DAA, direct acting antivirals; HCC; HCC, hepatocellular carcinoma; HCV; HCV, hepatitis C virus; LT, liver transplantation; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; WL, waitlist; baby boomer; direct-acting antiviral therapy; liver transplantation.

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Figures

Figure 1
Figure 1
Annual trends of birth cohort–specific prevalence of patients listed for liver transplantation and receiving liver transplantation in the United States.
Figure 2
Figure 2
Liver disease etiology–specific trends in patients listed for liver transplantation among the 1945–1965 birth cohort patients and non–1945–1965 birth cohort patients. WL, waitlist; HCV, hepatitis C virus; ALD, alcoholic liver disease; NASH, nonalcoholic steatohepatitis; HCC, hepatocellular carcinoma.
Figure 3
Figure 3
Liver disease etiology–specific trends in 1945–1965 birth cohort patients listed for liver transplantation with and without hepatocellular carcinoma. WL, waitlist; HCV, hepatitis C virus; ALD, alcoholic liver disease; NASH, nonalcoholic steatohepatitis; HCC, hepatocellular carcinoma.
Figure 4
Figure 4
Liver disease etiology–specific trends in patients receiving liver transplantation among the 1945–1965 birth cohort patients and non–1945–1965 birth cohort patients. LT, liver transplantation; HCV, hepatitis C virus; ALD, alcoholic liver disease; NASH, nonalcoholic steatohepatitis; HCC, hepatocellular carcinoma.
Figure 5
Figure 5
Liver disease etiology–specific trends in 1945–1965 birth cohort patients receiving liver transplantation with and without hepatocellular carcinoma. LT, liver transplantation; HCV, hepatitis C virus; ALD, alcoholic liver disease; NASH, nonalcoholic steatohepatitis; HCC, hepatocellular carcinoma.
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