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. 2022 May-Jun;12(3):908-916.
doi: 10.1016/j.jceh.2021.09.017. Epub 2021 Sep 25.

Nonalcoholic Steatohepatitis: A Rapidly Increasing Indication for Liver Transplantation in India

Dinesh Jothimani  1 , Silas Danielraj  1 , Gomathy Narasimhan  1 , Ilankumaran Kaliamoorthy  1 , Akila Rajakumar  1 , Kumar Palaniappan  1 , Swetha Palanichamy  1 , Ashwin Rammohan  1 , Hemalatha Ramachandran  1 , Rajesh Rajalingam  1 , Mohamed Rela  1
Affiliations

Nonalcoholic Steatohepatitis: A Rapidly Increasing Indication for Liver Transplantation in India

Dinesh Jothimani et al. J Clin Exp Hepatol. 2022 May-Jun.

Abstract

Background and aims: Recently, there has been a considerable increase in patients with nonalcoholic fatty liver disease. Availability of high-efficacy drugs for hepatitis B and hepatitis C virus (HCV) infection may have changed the disease prevalence. We aimed to study the impact of this changing epidemiology in patients undergoing liver transplantation (LT) over a 10-year period.

Methods: The study population was stratified into Period 1 (2009-2014) and Period 2 (2015-2019). Demographics, indications for LT and changes in the epidemiology between two periods were analysed. Aetiology-based posttransplant survival analysis was carried out.

Results: Indication for LT among 1017 adult patients (277 in Period 1 and 740 in Period 2) showed a significant increase in nonalcoholic steatohepatitis (NASH; 85 [30.7%] and 311 [42%]; P = 0.001), decrease in hepatitis C (49 [17.7%] and 75 [10.1%]; P = 0.002), and increase in hepatocellular carcinoma from Period 1 to Period 2 (13 [26.5%] to 38 [50.7%]; P = 0.009) among HCV patients. Patients transplanted for NASH had a lower 5-year survival compared with viral hepatitis (75.9% vs 87.4%; P = 0.03). There was a strong association between coronary artery disease and NASH (hazard ratio = 1.963, 95% confidence interval, 1.19-3.22).

Conclusion: NASH is the leading indication for liver transplantation in India, surpassing viral hepatitis in recent years.

Keywords: ASH, Non-alcoholic steatohepatitis; CAD, Coronary artery disease; CLD, Chronic liver disease; DAA, Direct acting antiviral drugs; DM, Diabetes mellitus; HBV, Hepatitis B virus infection; HCC, Hepatocellular carcinoma; HCV, Hepatitis C virus infection; LT, Liver transplantation; NAFLD, Non-alcoholic fatty liver disease; SVR, Sustained virological response; cardiovascular disease; hepatocellular carcinoma; liver transplantation; nonalcoholic steatohepatitis; viral hepatitis.

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Figures

Figure 1
Figure 1
Flowchart illustrating selection of study population.
Figure 2
Figure 2
Liver Transplantation between Period 1 (2009-2014) and Period 2 (2015-2019) based on disease etiology.
Figure 3
Figure 3
Kaplan-Meyer survival curves: 1-, 3- and 5-year survival after Liver transplantation based on their disease indications.
See this image and copyright information in PMC

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