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.

中文翻译：

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非酒精性脂肪性肝炎是美国肝移植增长最快的指征

背景与目标

由于肥胖趋势和病毒性肝炎治疗的进步，美国慢性肝病 (CLD) 的情况发生了变化。我们根据 CLD 病因评估了肝移植列表趋势。

方法

从移植受者科学登记处（2002 年至 2019 年）中选择肝移植的成人候选者。我们计算了被列入等候名单时常见 CLD 病因的比例趋势，包括慢性乙型肝炎病毒感染、慢性丙型肝炎病毒 (HCV) 感染、非酒精性脂肪性肝炎（NASH，包括隐源性肝硬化）、酒精相关性肝病(ALD) 无或无慢性 HCV 感染、自身免疫性肝炎、原发性胆汁性胆管炎和原发性硬化性胆管炎，适用于有或无肝细胞癌 (HCC) 的患者。

结果

在肝移植等候名单上的 168,441 名已知病因和非急性肝功能衰竭的患者中，27,799 名患者 (16.5%) 患有 HCC。2002 年，非 HCC 患者最常见的病因是慢性 HCV 感染 (37%) 和 ALD (16%)，而只有 5% 患有 NASH。在 HCC 患者中，58% 患有慢性 HCV 感染，10% 患有 ALD，只有 1% 患有 NASH。2019 年，在非 HCC 患者中，NASH 是肝移植的第二大适应症（28% 的患者），仅次于 ALD（38% 的患者）。在 HCC 患者中，慢性 HCV 感染仍然是主要适应症（40% 的患者），但 NASH（24% 的患者）超过 ALD（16% 的患者）成为第二大适应症。NASH 是非 HCC 女性 (34%)、54 岁以上患者 (36%) 和医疗保险患者 (41%) 的主要适应症。P < .001）和 HCC 患者（tau=0.94；P < .0001）。

结论

在对移植受者科学登记处（2002 年至 2019 年）的数据进行分析时，我们发现 NASH 是 2019 年肝移植的第二大最常见适应症，也是增长最快的适应症。2019 年，NASH 是非 HCC 女性肝移植的主要适应症。