Nonalcoholic Steatohepatitis Is the Most Rapidly Increasing Indication for Liver Transplantation in the United States

Abstract

BACKGROUND & AIMS:The profile of chronic liver disease (CLD) in the United States has changed due to obesity trends and advances in treatment of viral hepatitis. We assessed liver transplant listing trends by CLD etiology. METHODS:Adult candidates for liver transplantation were selected from the Scientific Registry of Transplant Recipients (2002 through 2019. We calculated proportion trends for common CLD etiologies at time of placement on the wait list, including chronic infection with hepatitis B virus, chronic infection with hepatitis C virus (HCV), nonalcoholic steatohepatitis (NASH, including cryptogenic cirrhosis), alcohol-related liver disease (ALD) without or with chronic HCV infection, autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis, in patients with and without hepatocellular carcinoma (HCC). RESULTS:From the 168,441 patients with known etiology and non-acute liver failure on the liver transplant waitlist, 27,799 patients (16.5%) had HCC. In 2002, the most common etiologies in patients without HCC were chronic HCV infection (37%) and ALD (16%), whereas only 5% had NASH. Among patients with HCC, 58% had chronic HCV infection and 10% had ALD and only 1% had NASH. In 2019, among patients without HCC, NASH was the second leading indication for liver transplantation (28% of patients), after ALD (38% of patients). Among patients with HCC, chronic HCV infection remained the leading indication (40% of patients) but NASH (24% of patients) surpassed ALD (16% of patients) to become the second leading indication. NASH was the leading indication in women without HCC (34%), in patients older than 54 years (36%), and in patients on Medicare (41%). In trend analysis, NASH was the most rapidly increasing indication for liver transplantation in patients without HCC (Kendall tau[0.97; P < .001) and in patients with HCC (tau[0.94; P < .0001). CONCLUSIONS:In an analysis of data from the Scientific Registry of Transplant Recipients (2002 through 2019), we found NASH to be the second most common indication for liver transplant in 2019, and the fastest increasing indication. In 2019, NASH was the leading indication for liver transplantation among women without HCC.

Recent updates on the management of autoimmune hepatitis

“…AIH with decompensated cirrhosis or ALF is indicated for LT. Among the listing of the Scientific Registry of Transplant Recipients (2002–2019) in the USA, 3.3% had AIH as the primary etiology [ 68 ]. In the trend analysis of the etiology of the Registry’s non-hepatocellular carcinoma LT listings, the rate of AIH during that period was stable.…”

Pathophysiology of NASH in endocrine diseases

“…NAFLD is now the most common cause of chronic liver disease in western countries, affecting approximately 30% of the general population, and its worldwide prevalence continues to increase concurrently due to the growing obesity epidemic ( 10 ). As such, NAFLD is projected to become the most common indication leading to liver transplantation in the United States soon ( 11 ). The prevalence of NAFLD can reach 90–95% in obese individuals and affects up to 70% of patients with type 2 ( 12 , 13 , 14 ).…”

Artificial intelligence in prediction of non‐alcoholic fatty liver disease and fibrosis

“…An updated systematic review suggests that the prevalence of NAFLD in Asia has reached 33.9% in 2012–2017 2 . In Western countries, NAFLD and its active form non‐alcoholic steatohepatitis (NASH) have become one of the leading indications for liver transplantation and an important cause of hepatocellular carcinoma 3 …”