Changes in the distribution of etiologies of cirrhosis among patients referred for liver transplantation over 11 years in Iran

Abstract

Background and aim: Cirrhosis is a major public health problem worldwide. The prevalence of cirrhosis is various in different geographical regions. The aim of the present study was to determine the distribution of the etiologies of cirrhosis and their proportional changes through recent 11 years in Iran. Methods: In this retrospective, observational study, the data of cirrhotic patients who have been listed for liver transplantation in the Namazi Transplant Center (Shiraz, Iran) between January 2006 and December 2016 were analyzed. Demographic and clinical data of the patients including model for end-stage liver disease score, year of registration, and the etiologic diagnosis for each patient were retrieved. Results: The ratio of males to females was the highest (2.6:1) in patients with age over 50 years. Of 4891 patients, hepatitis B virus cirrhosis had the highest frequency (23.53%) and alcoholic cirrhosis had the lowest frequency (1.70%). The percentages of waiting list patients with hepatitis B virus (34.48%–17.48%) (P < 0.001), autoimmune hepatitis (12.64%–8.50%) (P = 0.037), and alcoholic cirrhosis (2.30%–1.10%) were decreased (P = 0.008) and the percentages of waiting list patients with cholestatic (12.64%–25.20%) and nonalcoholic steatohepatitis cirrhosis (0.77%–8.82%) were increased over 11 years (both P < 0.001). Hepatitis B virus and autoimmune hepatitis cirrhosis were the most prevalent in male and female patients, respectively. Conclusion: The results of the present study showed an increase in the frequency of cholestasis and nonalcoholic steatohepatitis cirrhosis and therefore it should be considered in the health policy implementation.

Increasing Prevalence and High Survival Rate of Liver Transplanted Patients with NASH and PSC Cirrhosis

“…In addition, the proportion of some cirrhosis etiologies, such as non-alcoholic steatohepatitis (NASH) cirrhosis, has increased over time in the waitlist for LT, while the proportion of some cirrhosis etiologies, such as HBV cirrhosis, has decreased worldwide. 8 - 10 Similar to the frequency of patients with ESLD, the trend in the proportion of different etiologies on the waitlist for LT is not necessarily in accordance with the trend in the proportion of different etiologies in liver‐transplanted patients. The other important issue is the survival rate of LT patients.…”

Non-Alcoholic Steatohepatitis and Autoimmune Hepatitis Cirrhosis May Have a Higher Risk of Progression to Hepatocellular Carcinoma

“…The main causes of cirrhosis include viral infections such as hepatitis B virus (HBV) and hepatitis C virus (HCV), alcohol-induced fatty liver disease (AFLD), cholestasis-related conditions like primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH), and metabolic disorders like non-alcoholic fatty liver disease (NAFLD). While viral infections were previously known to be the most common causes of liver cirrhosis, their prevalence has decreased due to HBV vaccination (2). On the other hand, the prevalence of cirrhosis due to cholestasis, AIH, and, specifically, non-alcoholic steatohepatitis (NASH) has been increasing in recent years (2).…”

“…While viral infections were previously known to be the most common causes of liver cirrhosis, their prevalence has decreased due to HBV vaccination (2). On the other hand, the prevalence of cirrhosis due to cholestasis, AIH, and, specifically, non-alcoholic steatohepatitis (NASH) has been increasing in recent years (2). It has been suggested that immune-mediated mechanisms play a crucial role in the development of these types of cirrhosis, with autoantibodies being prominent in AIH, PSC, and NASH cirrhosis (3).…”

GADD45aa as a Predictive Biomarker for Aeromonas Infection–Related Liver Cirrhosis

“…Liver cirrhosis is recognized as the 11th leading cause of mortality in the world [1]. Cirrhosis is the last pathological outcome of different chronic liver disorders, and newer research has established that fibrosis is the starter of cirrhosis [2][3][4]. Many types of factors are involved in the beginning and development of liver fibrosis and cirrhosis [3].…”