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. 2021 Mar;19(3):580-589.e5.
doi: 10.1016/j.cgh.2020.05.064. Epub 2020 Jun 9.

Nonalcoholic Steatohepatitis Is the Most Rapidly Increasing Indication for Liver Transplantation in the United States

Zobair M Younossi  1 , Maria Stepanova  2 , Janus Ong  3 , Greg Trimble  4 , Saleh AlQahtani  5 , Issah Younossi  2 , Aijaz Ahmed  6 , Andrei Racila  7 , Linda Henry  2
Affiliations

Nonalcoholic Steatohepatitis Is the Most Rapidly Increasing Indication for Liver Transplantation in the United States

Zobair M Younossi et al. Clin Gastroenterol Hepatol. 2021 Mar.

Abstract

Background & aims: The profile of chronic liver disease (CLD) in the United States has changed due to obesity trends and advances in treatment of viral hepatitis. We assessed liver transplant listing trends by CLD etiology.

Methods: Adult candidates for liver transplantation were selected from the Scientific Registry of Transplant Recipients (2002 through 2019). We calculated proportion trends for common CLD etiologies at time of placement on the wait list, including chronic infection with hepatitis B virus, chronic infection with hepatitis C virus (HCV), nonalcoholic steatohepatitis (NASH, including cryptogenic cirrhosis), alcohol-related liver disease (ALD) without or with chronic HCV infection, autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis, in patients with and without hepatocellular carcinoma (HCC).

Results: From the 168,441 patients with known etiology and non-acute liver failure on the liver transplant waitlist, 27,799 patients (16.5%) had HCC. In 2002, the most common etiologies in patients without HCC were chronic HCV infection (37%) and ALD (16%), whereas only 5% had NASH. Among patients with HCC, 58% had chronic HCV infection and 10% had ALD and only 1% had NASH. In 2019, among patients without HCC, NASH was the second leading indication for liver transplantation (28% of patients), after ALD (38% of patients). Among patients with HCC, chronic HCV infection remained the leading indication (40% of patients) but NASH (24% of patients) surpassed ALD (16% of patients) to become the second leading indication. NASH was the leading indication in women without HCC (34%), in patients older than 54 years (36%), and in patients on Medicare (41%). In trend analysis, NASH was the most rapidly increasing indication for liver transplantation in patients without HCC (Kendall tau=0.97; P < .001) and in patients with HCC (tau=0.94; P < .0001).

Conclusions: In an analysis of data from the Scientific Registry of Transplant Recipients (2002 through 2019), we found NASH to be the second most common indication for liver transplant in 2019, and the fastest increasing indication. In 2019, NASH was the leading indication for liver transplantation among women without HCC.

Keywords: Etiology; Incidence; Liver cancer; Time periods.

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Comment in

  • The Rising Tide of Nonalcoholic Fatty Liver Disease: How Much Time Until the Flood Reaches Our Coast?
    Mazzarelli C, Angrisani D, Viganò R. Mazzarelli C, et al. Clin Gastroenterol Hepatol. 2021 Jun;19(6):1299. doi: 10.1016/j.cgh.2020.07.025. Epub 2020 Nov 26. Clin Gastroenterol Hepatol. 2021. PMID: 33248075 No abstract available.
  • Reply.
    Stepanova M, Younossi Z. Stepanova M, et al. Clin Gastroenterol Hepatol. 2021 Jun;19(6):1299-1300. doi: 10.1016/j.cgh.2020.07.038. Epub 2020 Nov 26. Clin Gastroenterol Hepatol. 2021. PMID: 33248088 No abstract available.

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