Gastroenterology

Gastroenterology

Volume 148, Issue 3, March 2015, Pages 547-555
Gastroenterology

Original Research
Full Report: Clinical—Liver
Nonalcoholic Steatohepatitis Is the Second Leading Etiology of Liver Disease Among Adults Awaiting Liver Transplantation in the United States

https://doi.org/10.1053/j.gastro.2014.11.039Get rights and content

Background & Aims

Nonalcoholic steatohepatitis (NASH) has been predicted to become the leading indication for liver transplantation (LT) in the United States. However, few studies have evaluated changes in the etiology of liver diseases among patients awaiting LT, and none have focused on the effects of NASH on liver transplant waitlists in the United States.

Methods

We collected data from the United Network for Organ Sharing and Organ Procurement and Transplantation Network registry from 2004 through 2013, on liver transplant waitlist registrants with hepatitis C virus (HCV) infection, NASH, alcoholic liver disease (ALD), or a combination of HCV infection and ALD. We compared differences in survival within 90 days of registration (90-day survival) and probability of LT among patients with different diseases using Kaplan-Meier and multivariate logistic regression models.

Results

Between 2004 and 2013, new waitlist registrants with NASH increased by 170% (from 804 to 2174), with ALD increased by 45% (from 1400 to 2024), and with HCV increased by 14% (from 2887 to 3291); registrants with HCV and ALD decreased by 9% (from 880 to 803). In 2013, NASH became the second-leading disease among liver transplant waitlist registrants, after HCV. Patients with ALD had a significantly higher mean Model for End-Stage Liver Disease score at time of waitlist registration than other registrants. However, after multivariate adjustment, patients with ALD were less likely to die within 90 days when compared with patients with NASH (odds ratio [OR] = 0.77; 95% confidence interval [CI]: 0.67–0.89; P < .001); patients with HCV infection or HCV and ALD had similar odds for 90-day survival compared with NASH patients. Compared with patients with NASH, patients with HCV (OR = 1.45; 95% CI: 1.35–1.55; P < .001), ALD (OR = 1.15; 95% CI: 1.06–1.24; P < .001), or HCV and ALD (OR = 1.29; 95% CI: 1.18–1.42; P < .001) had higher odds for 90-day survival.

Conclusions

Based on data from US adult LT databases, since 2004 the number of adults with NASH awaiting LTs has almost tripled. However, patients with NASH are less likely to undergo LT and less likely to survive for 90 days on the waitlist than patients with HCV, ALD, or HCV and ALD.

Section snippets

Study Population

Adult patients (aged 18 years and older) with chronic liver disease who were registered on the waitlist for liver transplants in the United States from 2004 to 2013 were evaluated using UNOS/OPTN registry data. The etiology of chronic liver disease leading to waitlist registration was determined based on disease diagnosis coding in UNOS/OPTN. Among patients with HCC, the underlying liver disease was determined based on the secondary disease diagnosis codes provided. Patients with both HCV and

Overview

From 2004 to 2013, the overall 4 leading etiologies of chronic liver disease among adult liver transplant waitlist registrants were HCV, ALD, NASH, and HCV/ALD, accounting for 35.2%, 18.3%, 15.8%, and 9.7% of liver transplant waitlist registrants, respectively.

Characteristics of Study Cohort

Compared with patients with NASH, there was a significantly greater proportion of men among patients with HCV (69.8%, n = 21,620), ALD (76.5%, n = 12,338), and HCV/ALD (83.1%, n = 7,111) (Table 1). Waitlist patients with NASH were older

Discussion

Although HCV remains the leading etiology of chronic liver disease among new liver transplant waitlist registrations, NASH demonstrated the greatest increase from 2004 to 2013, and in 2013, NASH became the second leading etiology. Patients with ALD were more likely to survive 90 days on the waitlist compared with NASH patients, but no difference in waitlist mortality was seen among HCV and HCV/ALD patients when compared with NASH patients. Compared with NASH, patients with HCV, ALD, and HCV/ALD

References (28)

  • K.M. Flegal et al.

    Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010

    JAMA

    (2012)
  • K.F. Adams et al.

    Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old

    N Engl J Med

    (2006)
  • A. Must et al.

    The disease burden associated with overweight and obesity

    JAMA

    (1999)
  • N. Chalasani et al.

    The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

    Hepatology

    (2012)

    • Cited by (0)

    This article has an accompanying continuing medical education activity on page e14. Learning Objective: Upon completion of this CME exercise, successful learners will be able to explain the impact of the rising prevalence of nonalcoholic steatohepatitis on liver transplant waitlist registrations in the US.

    Conflicts of interest The authors disclose no conflicts.

    View full text
    Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.