Changing trends in liver transplantation indications in Saudi Arabia: from hepatitis C virus infection to nonalcoholic fatty liver disease

Alqahtani, Saleh A.; Broering, Dieter; Alghamdi, Saad; Bzeizi, Khalid; Alhusseini, Noara; Alabbad, Saleh; Albenmousa, Ali; Alfaris, Nasreen; Abaalkhail, Faisal; Al–Hamoudi, Waleed

doi:10.1186/s12876-021-01828-z

Cited by 15 publications

(11 citation statements)

References 44 publications

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“…However, it has been shown that PSC and AIH cirrhosis had a low proportion among patients who underwent LT in the country. 17 In contrast, another study reported that the proportion of alcoholic cirrhosis, the third leading indication for LT, and NASH cirrhosis increased between 2000 and 2015, while the proportion of HCV cirrhosis decreased during the study period in the United States. 18 In accordance with our study, an analysis of data collected from UK and US national liver transplant registries between 1995 and 2014 declared that PSC is the leading indication for LT among patients with autoimmune liver diseases, including PSC, PBC, and AIH.…”

Section: Discussionmentioning

confidence: 92%

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

Khajehahmadi,

Nikeghbalian,

Roshanaei

et al. 2024

Arch Iran Med

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Background: Epidemiological studies on liver transplant (LT) patients can provide valuable information about the etiology and trends of cirrhosis. The present study aimed to investigate the prevalence and trend of different etiologies and survival rates of LT patients at the Namazi Transplant Center in Shiraz, Iran, between 2001 and 2018. Methods: In this single-center, retrospective cohort study, the demographic and clinical characteristics of 3751 patients who underwent LT and met the study inclusion criteria, including age, gender, blood group, body mass index, model for end-stage liver disease (MELD) score, cause of cirrhosis, and diabetes, were extracted from patients’ physical or electronic medical records between 2001 and 2018. Results: The MELD scores of LT patients with primary sclerosing cholangitis (PSC), hepatitis B virus (HBV), and non-alcoholic steatohepatitis (NASH) cirrhosis significantly decreased over the study period (P<0.001). Among the LT patients, HBV infection had the highest frequency (21.09%), followed by cryptogenic (17.33%) and PSC (17.22%). The proportion of patients with PSC and NASH (both P<0.001) cirrhosis was significantly increased, so that PSC cirrhosis (2016: 19.4%, 2018: 18.8%) surpassed HBV (2016: 18.4%, 2018: 13.5%), autoimmune hepatitis (2016: 11.7%, 2018: 12.7%), and cryptogenic cirrhosis (2016: 16.1%, 2018:14%) as the leading indication for LT from 2016 to the end of the study period. Fortunately, these patients had a better survival rate than other common diseases (HR: 0.53, CI: 0.43‒0.66; P<0.001). Conclusion: The proportion of NASH and PSC cirrhosis significantly increased during the 18 years of study. However, these patients had an improved survival rate. Therefore, health organizations should pay more attention to non-communicable diseases, especially fatty liver disease and cholangitis.

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Section: Discussionmentioning

confidence: 92%

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

Khajehahmadi,

Nikeghbalian,

Roshanaei

et al. 2024

Arch Iran Med

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“…Our study was limited by the availability of data, and we used data from outside of SA for certain microsimulation modules. We identified a need for more up-to-date, national, and regionally representative data on obesity incidence and prevalence, as well as specific liver diseases such as NAFLD, which are on the rise in SA [ 19 ]. More frequent, high-quality data will enable more detailed modelling of the associations between obesity and NCDs in SA and more accurate projections of the economic and health burden from NCDs.…”

Section: Discussionmentioning

confidence: 99%

“…A more serious NAFLD variantnon-alcoholic steatohepatitis (NASH)is linked to advanced liver fibrosis, cirrhosis, and liver cancer [18]. NASH has overtaken hepatitis C virus as the most common indication for liver transplants in SA [19]. The health and economic burden of T2DM, liver disease, and liver cancer could be dramatically reduced with effective obesity policies and lifestyle interventions [20][21][22].…”

Section: Introductionmentioning

confidence: 99%

How Could Different Obesity Scenarios Alter the Burden of Type 2 Diabetes and Liver Disease in Saudi Arabia?

Coker¹,

Saxton²,

Retat³

et al. 2023

Obes Facts

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Introduction Obesity is a major risk factor for type 2 diabetes (T2DM) and liver disease, and obesity-attributable liver disease is a common indication for liver transplant. Obesity prevalence in Saudi Arabia (SA) has increased in recent decades. SA has committed to the WHO ‘halt obesity’ target to shift prevalence to 2010 levels by 2025. We estimated the future benefits of reducing obesity in SA on incidence and costs of T2DM and liver disease under two policy scenarios: 1) SA meets the ‘halt obesity’ target; 2) population body mass index (BMI) is reduced by 1% annually from 2020 to 2040. Methods We developed a dynamic microsimulation of working-age people (20-59 years) in SA between 2010 and 2040. Model inputs included population demographic, disease and healthcare cost data, and relative risks of diseases associated with obesity. In our two policy scenarios, we manipulated population BMI and compared predicted disease incidence and associated healthcare costs to a baseline ‘no change’ scenario. Results Adults <35 years are expected to meet the ‘halt obesity’ target, but those ≥35 years are not. Obesity is set to decline for females, but to increase amongst males 35-59 years. If SA’s working-age population achieved either scenario, >1.15 million combined cases of T2DM, liver disease and liver cancer could be avoided by 2040. Healthcare cost savings for the ‘halt obesity’ and 1% reduction scenarios are 46.7 and 32.8 billion USD, respectively. Discussion/Conclusion SA’s younger working-age population is set to meet the ‘halt obesity’ target, but those aged 35-59 are off-track. Even a modest annual 1% BMI reduction could result in substantial future health and economic benefits. Our findings strongly support universal initiatives to reduce population-level obesity, with targeted initiatives for working-age people ≥35 years of age.

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“…In SA, NAFLD has overtaken hepatitis-induced liver disease as the main indication for liver transplants [ 12 ]. Challenges in diagnosis and surveillance of NAFLD and NASH, including patient unawareness or neglect, missed diagnosis, lack of or absence of symptoms, mean that estimates of the population burden of obesity-related liver disease are limited to a few studies [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

The future health and economic burden of obesity-attributable type 2 diabetes and liver disease among the working-age population in Saudi Arabia

Coker¹,

Saxton²,

Retat³

et al. 2022

PLoS ONE

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Background Obesity and type 2 diabetes (T2DM) are increasing in Saudi Arabia (SA). Among other conditions, these risk factors increase the likelihood of non-alcoholic fatty liver disease (NAFLD), which in turn increases risks for advanced liver diseases, such as non-alcoholic steatohepatitis (NASH), cirrhosis and cancer. The goal of this study was to quantify the health and economic burden of obesity-attributable T2DM and liver disease in SA. Methods We developed a microsimulation of the SA population to quantify the future incidence and direct health care costs of obesity-attributable T2DM and liver disease, including liver cancer. Model inputs included population demographics, body mass index, incidence, mortality and direct health care costs of T2DM and liver disease and relative risks of each condition as a function of BMI category. Model outputs included age- and sex-disaggregated incidence of obesity-attributable T2DM and liver disease and their direct health care costs for SA’s working-age population (20–59 years) between 2020 and 2040. Results Between 2020 and 2040, the available data predicts 1,976,593 [± 1834] new cases of T2DM, 285,346 [±874] new cases of chronic liver diseases, and 2,101 [± 150] new cases of liver cancer attributable to obesity, amongst working-age people. By 2040, the direct health care costs of these obesity-attributable diseases are predicted to be 127,956,508,540 [± 51,882,446] USD. Conclusions The increase in obesity-associated T2DM and liver disease emphasises the urgent need for obesity interventions and strategies to meaningfully reduce the future health and economic burden of T2DM, chronic liver diseases and liver cancer in SA.

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Changing trends in liver transplantation indications in Saudi Arabia: from hepatitis C virus infection to nonalcoholic fatty liver disease

Cited by 15 publications

References 44 publications

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

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

How Could Different Obesity Scenarios Alter the Burden of Type 2 Diabetes and Liver Disease in Saudi Arabia?

The future health and economic burden of obesity-attributable type 2 diabetes and liver disease among the working-age population in Saudi Arabia

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