Liver Transplantation for Nonalcoholic Steatohepatitis in the US: Temporal Trends and Outcomes

Cholankeril, George; Wong, Robert J.; Hu, Menghan; Perumpail, Ryan B.; Yoo, Eric R.; Puri, Puneet; Younossi, Zobair M.; Harrison, Stephen A.; Ahmed, Aijaz

doi:10.1007/s10620-017-4684-x

Cited by 204 publications

(170 citation statements)

References 23 publications

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“…In contrast, the demand for LT for hepatitis C virus (HCV) has declined since 2015 following the introduction of safe and effective direct‐acting antivirals. Consequently, current trends suggest that NASH will surpass HCV as the most common indication for LT in the United States within the next 10 years …”

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confidence: 99%

Increasing Incidence of Nonalcoholic Steatohepatitis as an Indication for Liver Transplantation in Australia and New Zealand

et al. 2019

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The worldwide increase in obesity and diabetes has led to predictions that nonalcoholic steatohepatitis (NASH) will become the leading indication for orthotopic liver transplantation (OLT). Data supporting this prediction from outside the United States are limited. Thus, we aimed to determine trends in the frequency of NASH among adults listed and undergoing OLT in Australia and New Zealand (ANZ) from 1994 to 2017. Data from the ANZ Liver Transplant Registry were analyzed with patients listed for fulminant liver failure, retransplantation, or multivisceral transplants excluded. Nonparametric trend, Spearman rank correlation, and regression analysis were used to assess trends in etiologies of liver disease over time. Of 5016 patient wait‐list registrants, a total of 3470 received an OLT. The percentage of patients with NASH activated for OLT increased significantly from 2.0% in 2003 to 10.9% in 2017 (trend analyses; P < 0.001). In 2017, NASH was the third leading cause of chronic liver disease (CLD) among wait‐list registrants behind chronic hepatitis C virus (HCV; 29.5%) and alcohol (16.1%). Similarly, significant increases over time in the percentage of patients undergoing OLT were observed for HCV and NASH (all trend analyses; P < 0.001) but with significant reductions in primary sclerosing cholangitis and cryptogenic cirrhosis (both P < 0.05). By 2017, NASH was the third leading cause of liver disease among patients undergoing OLT (12.4%) and behind chronic HCV (30.2%) and alcohol (18.2%). NASH also became the third most frequent etiology of CLD in patients transplanted (13.8%) with concomitant hepatocellular carcinoma by 2017. In conclusion, NASH is increasing as a primary etiology of liver disease requiring listing and liver transplantation in ANZ.

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confidence: 99%

Increasing Incidence of Nonalcoholic Steatohepatitis as an Indication for Liver Transplantation in Australia and New Zealand

et al. 2019

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“…The outcomes of LT for NASH were similar to those of LT performed for ALD. Patients with NASH who underwent LT experienced superior outcomes compared to those reported for LT of HCV recipients in the USA [3]. There are reasons to believe that future studies may yield results different than those reported for LTs performed from 2003 to 2014.…”

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confidence: 83%

“…In this issue of Digestive Diseases and Sciences, Cholankeril et al [3] report on the temporal trends and outcomes of LT for NASH in the USA based on a review of the United Network for Organ Sharing and Organ Procurement and Cholankeril et al have reclassified from CC to NASH the cases of all obese patients (BMI C 30 kg/m 2 ) that underwent LT for CC [3]. This measure was clearly justified, as it is now accepted that the majority of CC patients actually have undiagnosed NASH [4].…”

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confidence: 99%

“…As of 2014, 20% of American teenagers and 36% of adults are obese (BMI C 30 kg/m 2 ) [3]. Since NASH was first assigned as a diagnostic category by United Network for Organ Sharing (UNOS) in 2001 [3], the prevalence of NASH as an indication for liver transplantation (LT) was unknown prior to 2001. Most cases that were formerly classified as cryptogenic cirrhosis (CC) were most likely cases of NASH-induced end-stage liver disease (ESLD).…”

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confidence: 99%

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Nonalcoholic Steatohepatitis: The Second Leading Indication for Liver Transplantation in the USA

Chedid

2017

Dig Dis Sci

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“…Later stages are NASH, with the risk of progressing to liver cirrhosis including the so‐called “cryptogenic” cirrhosis, which is still debatable, and eventually hepatocellular carcinoma (HCC) . A liver transplantation may be the therapy of choice . Defining various stages of obesity‐related liver diseases requires a liver histology, considered the gold standard, obtained by invasive liver biopsy .…”

Section: Nafld and Nashmentioning

confidence: 99%

Is obesity rather than the dietary supplement used for weight reduction the cause of liver injury?

et al. 2018

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Acute liver injury has been attributed to dietary supplements (DS) used for weight loss, but their causal role was much questioned, and obesity as an alternative cause of the liver injury remained unclear. A comprehensive search of the Medline database was conducted with terms that included “DS,” “liver injury,” “obesity,” “obesity‐related liver diseases,” and “nonalcoholic steatohepatitis.” For each term, we focused on the first 50 publications. We undertook a manual search to identify additional reports. Underlying liver diseases and other health issues are common in patients taking DS for weight reduction. These include obesity or morbid obesity, as well as complex metabolic disorders complicated by excess morbidity and mortality due to associated liver diseases. Among these are nonalcoholic fatty liver disease with potential progression to nonalcoholic steatohepatitis and cirrhosis, often classified as cryptogenic with a rare risk of hepatocellular carcinoma. With the exception of hepatocellular carcinoma, these obesity‐related liver diseases were observed to varying degrees in patients, and some even required a liver transplant. This raises the question whether the liver injury that occurred in these patients is due to DS consumed for weight loss or to the underlying obesity‐related liver diseases. This analysis showed that, in many instances, the causal role of obesity has been neglected. Obesity‐associated liver diseases should be considered as differential diagnosis of liver injury in obese patients using DS.

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Liver Transplantation for Nonalcoholic Steatohepatitis in the US: Temporal Trends and Outcomes

Abstract: Currently, NASH is the most rapidly growing indication for LT in the US. Despite resurgence in ALD, NASH remains the second leading indication for LT.

Cited by 204 publications

References 23 publications

Increasing Incidence of Nonalcoholic Steatohepatitis as an Indication for Liver Transplantation in Australia and New Zealand

Increasing Incidence of Nonalcoholic Steatohepatitis as an Indication for Liver Transplantation in Australia and New Zealand

Nonalcoholic Steatohepatitis: The Second Leading Indication for Liver Transplantation in the USA

Is obesity rather than the dietary supplement used for weight reduction the cause of liver injury?

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