Projected increase in obesity and non‐alcoholic‐steatohepatitis–related liver transplantation waitlist additions in the United States

Parikh, Neehar D.; Marrero, Wesley J.; Wang, Jingyuan; Steuer, Justin; Tapper, Elliot B.; Konerman, Monica A.; Singal, Amit G.; Hutton, David; Byon, Eunshin; Lavieri, Mariel S.

doi:10.1002/hep.29473

Cited by 101 publications

(92 citation statements)

References 36 publications

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“…(7)(8)(9) Even as the burden of hepatitis C virus (HCV) wanes given highly effective antiviral therapy, (9) cirrhosis mortality rose by 65% from 2008 to 2016 and is expected to triple by 2030. (10)(11)(12)(13)(14) It is unclear how these trends impact the burden of HE.…”

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Incidence of and Risk Factors for Hepatic Encephalopathy in a Population‐Based Cohort of Americans With Cirrhosis

et al. 2019

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Hepatic encephalopathy (HE) is a devastating complication of cirrhosis. Data are limited regarding the incidence of and risk factors for HE among contemporary patients in the context of the shifting epidemiology of cirrhosis. We examined a 20% random sample of U.S. Medicare enrollees with cirrhosis and Part D prescription coverage from 2008 to 2014. We modelled incident HE using demographic, clinical, and pharmacologic data. Risk factors for HE were evaluated, including demographics/socioeconomics, cirrhosis etiology, severity of liver disease, and pharmacotherapy, along with gastroenterology consultation, as time‐varying covariates. Among 166,192 Medicare enrollees with cirrhosis followed for 5.25 (interquartile range [IQR], 2.00‐7.00) years, the overall incidence of HE was 11.6 per 100 patient‐years. The cohort's median age was 65 years (IQR, 57‐72), 31% had alcohol‐related cirrhosis, and 49% had likely nonalcoholic fatty liver disease cirrhosis. The two strongest associations with HE were alcohol‐related cirrhosis (adjusted hazard ratio [AHR], 1.44; 95% confidence interval [CI], 1.40, 1.47, relative to nonalcoholic nonviral cirrhosis) and the presence of portal hypertension (AHR, 3.42; 95% CI, 3.34, 3.50). Adjusting for confounders, benzodiazepines (AHR, 1.24; 95% CI, 1.21, 1.27), gamma aminobutyric acid (GABA)ergics (AHR, 1.17; 95% CI, 1.14, 1.21), opioids (AHR, 1.24; 95% CI, 1.21, 1.27), and proton pump inhibitors (PPIs) (AHR, 1.41; 95% CI, 1.38, 1.45) were all associated with incident HE. Only benzodiazepines, however, were associated with the risk of hospitalization with HE (incidence‐rate ratio, 1.23; 95% CI, 1.20, 1.26). Conclusion: Novel data regarding the risk of HE for contemporary patients with cirrhosis are provided. The incidence of HE in an older population of Americans with cirrhosis is high, particularly among those with alcohol‐related cirrhosis and portal hypertension. Several medication classes, namely PPIs, opiates, GABAergics, and benzodiazepines, represent potentially modifiable risk factors for HE.

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Incidence of and Risk Factors for Hepatic Encephalopathy in a Population‐Based Cohort of Americans With Cirrhosis

et al. 2019

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“…NAFLD is associated with obesity, type II diabetes mellitus, dyslipidemia, metabolic syndrome, and cardiovascular disease . Due to inflammation and hepatocyte injuries in subsets of population with NAFLD, growing numbers of NAFLD patients are indicated for liver transplantation or present with hepatocellular carcinoma . Affecting ~25% of the global population, NAFLD is now an epidemic that poses significant clinical and economic burdens worldwide …”

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“…inflammation and hepatocyte injuries in subsets of population with NAFLD, growing numbers of NAFLD patients are indicated for liver transplantation or present with hepatocellular carcinoma. 1,4,5 Affecting~25% of the global population, NAFLD is now an epidemic that poses significant clinical and economic burdens worldwide. 3 Because there is no alternative specific test for hepatic steatosis quantification, histopathologic analysis of the liver tissue via percutaneous biopsy is still the reference standard for quantifying and grading hepatic steatosis, despite inherent invasiveness and sampling bias of biopsy.…”

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Accuracy and precision of proton density fat fraction measurement across field strengths and scan intervals: A phantom and human study

Kim

Cho

Kim

et al. 2018

Magnetic Resonance Imaging

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Background Complex‐based chemical shift imaging‐based magnetic resonance imaging (CSE‐MRI) is emerging as a preferred method for noninvasively quantifying proton density fat fraction (PDFF), a promising quantitative imaging biomarker (QIB) for longitudinal hepatic steatosis measurement. Purpose To determine linearity, bias, repeatability, and reproducibility of the PDFF measurement using CSE‐MRI (CSE‐PDFF) across scan intervals, MR field strengths, and readers in phantom and nonalcoholic fatty liver disease (NAFLD) patients. Study Type Institutional Review Board (IRB)‐approved prospective. Subjects Fat‐water phantom and 20 adult patients. Field Strength/Sequence 1.5 T and 3.0 T MR systems and a commercially available CSE‐MRI sequence (IDEAL‐IQ). Assessment Two independent readers measured CSE‐PDFF of fat‐water phantom and NAFLD patients across two field strengths and scan intervals (same‐day and 2‐week) each and in a combination of both. MR spectroscopy‐based PDFF (MRS‐PDFF) was used as the reference standard for phantom PDFF. Statistical Tests Linearity and bias of measurement were evaluated by linear regression analysis and Bland–Altman plots, respectively. Repeatability and reproducibility were assessed by coefficient of variance and repeatability / reproducibility coefficients (RC). The intraclass correlation coefficient was used to validate intra‐ and interobserver agreements. Results CSE‐PDFF showed high linearity and small bias (–0.6–0.4 PDFF%) with 95% limits of agreement within ±2.9 PDFF% across field strengths, 2‐week interscan period, and readers in the clinical scans. CSE‐PDFF was highly repeatable and reproducible both in phantom and clinical scans, with the largest observed RC across field strengths and 2‐week interscan period being 3 PDFF%. Data Conclusion CSE‐PDFF is a robust QIB with high linearity, small bias, and excellent repeatability/reproducibility. A change of more than 3 PDFF% across field strengths within 2 weeks of scan interval likely reflects a true change, which is well within the clinically acceptable range. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:305–314.

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“…the United States. (9) The authors used data from the OPTN database from 2000 to 2014, the continuous National Health and Nutrition Examination Survey from 1999 to 2014, and the Behavioral Risk Factor Surveillance System from 2000 to 2014 in order to determine the historical number of wait-list additions per year, to obtain estimates of national obesity prevalence per year, to estimate obesity prevalence by year and regional divisions instituted by the United Network of Organ Sharing.…”

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“…It is in this context of NAFLD as the main indication for liver transplantation and the impact of obesity in the outcomes of liver transplantation that Parikh and colleagues evaluated the temporal trends in the rise of obesity and NAFLD‐related wait‐list additions and made projections for the future burden of NAFLD on the liver transplant wait list in the United States . The authors used data from the OPTN database from 2000 to 2014, the continuous National Health and Nutrition Examination Survey from 1999 to 2014, and the Behavioral Risk Factor Surveillance System from 2000 to 2014 in order to determine the historical number of wait‐list additions per year, to obtain estimates of national obesity prevalence per year, to estimate obesity prevalence by year and regional divisions instituted by the United Network of Organ Sharing.…”

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Obesity and Liver Disease: The New Era of Liver Transplantation

Marrero

2019

Hepatology

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Projected increase in obesity and non‐alcoholic‐steatohepatitis–related liver transplantation waitlist additions in the United States

Abstract: We project a marked increase in demand for LT for NASH given population obesity trends. Continued public health efforts to curb obesity prevalence are needed to reduce the projected future burden of NASH. (Hepatology 2017).

Cited by 101 publications

References 36 publications

Incidence of and Risk Factors for Hepatic Encephalopathy in a Population‐Based Cohort of Americans With Cirrhosis

Incidence of and Risk Factors for Hepatic Encephalopathy in a Population‐Based Cohort of Americans With Cirrhosis

Accuracy and precision of proton density fat fraction measurement across field strengths and scan intervals: A phantom and human study

Obesity and Liver Disease: The New Era of Liver Transplantation

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