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. 2023 Dec 22;8(1):e0352.
doi: 10.1097/HC9.0000000000000352. eCollection 2024 Jan 1.

The changing epidemiology of adult liver transplantation in the United States in 2013-2022: The dominance of metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease

Zobair M Younossi  1   2 , Maria Stepanova  1   2 , Reem Al Shabeeb  1 , Katherine E Eberly  1 , Dipam Shah  1 , Veronica Nguyen  1 , Janus Ong  2   3 , Linda Henry  1   2   4 , Saleh A Alqahtani  1   4   5
Affiliations

The changing epidemiology of adult liver transplantation in the United States in 2013-2022: The dominance of metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease

Zobair M Younossi et al. Hepatol Commun. .

Abstract

Background: The high prevalence of obesity in the United States drives the burden of NASH, recently renamed as metabolic dysfunction-associated steatohepatitis (MASH). We assessed the most recent trends in liver transplantation in the United States.

Methods: The Scientific Registry of Transplant Recipients (SRTR 2013-2022) was used to select adult (18 years or above) candidates who underwent liver transplant.

Results: There were 116,292 candidates who underwent liver transplant with known etiology of chronic liver disease. In candidates without HCC, the most common etiology was alcohol-associated liver disease (ALD), increasing from 23% (2013) to 48% (2022), followed by NASH/MASH, which increased from 19% to 27%; the rates of viral hepatitis decreased (chronic hepatitis C: 28%-4%; chronic hepatitis B: 1.8%-1.1%) (all trend p<0.01). The proportion of HCC decreased from 25% (2013-2016) to 17% (2021-2022). Among HCC cohort, the proportion of chronic hepatitis C decreased from 60% (2013) to 27% (2022), NASH/MASH increased from 10% to 31%, alcohol-associated liver disease increased from 9% to 24% (trend p<0.0001), and chronic hepatitis B remained stable between 5% and 7% (trend p=0.62). The rapid increase in the proportion of NASH/MASH in HCC continued during the most recent study years [20% (2018), 28% (2020), 31% (2022)]; the trend remained significant after adjustment for age, sex, ethnicity, obesity, and type 2 diabetes.

Conclusions: Liver transplant etiologies in the United States have changed over the last decade. Alcohol-associated liver disease and NASH/MASH remain the 2 most common indications for transplantation among those without HCC, and NASH/MASH is the most common in patients with HCC.

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Conflict of interest statement

The authors have no conflicts to report.

Figures

FIGURE 1
FIGURE 1
Distributions of CLD etiologies among adult candidates with and without HCC who underwent liver transplant. Abbreviations: AIH, ALD, alcohol-associated liver disease; CHB, chronic hepatitis B; CHC, chronic hepatitis C; CLD, chronic liver disease; PBC, primary biliary cholangitis; PSC, primary sclerosing cholangitis.
See this image and copyright information in PMC

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