Nonalcoholic Steatohepatitis Is the Fastest Growing Cause of Hepatocellular Carcinoma in Liver Transplant Candidates.
- Younossi Z Center for Liver Diseases, Department of Medicine, Inova Health System, Falls Church, Virginia; Division of Gastroenterology and Hepatology, Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia. Electronic address: zobair.younossi@inova.org.
- Stepanova M Center for Outcomes Research in Liver Disease, Washington, District of Columbia.
- Ong JP Department of Medicine, University of Philippines, Manila, Philippines.
- Jacobson IM Division of Gastroenterology and Hepatology, New York University School of Medicine, New York, New York.
- Bugianesi E Division of Gastroenterology, Department of Medical Sciences, University of Torino, Torino, Italy.
- Duseja A Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
- Eguchi Y Liver Center, Saga University Hospital, Saga, Japan.
- Wong VW Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
- Negro F Division of Gastroenterology and Hepatology, University of Geneva, Geneva, Switzerland.
- Yilmaz Y Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey.
- Romero-Gomez M Digestive Diseases Unit, Virgin del Rocio University Hospital, Sevilla, Spain.
- George J Sorr Liver Centre, The Westmead Institute of Medical Research, University of Sydney, Westmead Hospital, Sydney, Australia.
- Ahmed A Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California.
- Wong R Division of Gastroenterology and Hepatology, Alameda Health System, Oakland, California.
- Younossi I Center for Outcomes Research in Liver Disease, Washington, District of Columbia.
- Ziayee M Center for Outcomes Research in Liver Disease, Washington, District of Columbia.
- Afendy A Center for Outcomes Research in Liver Disease, Washington, District of Columbia.
- 2018-06-17
Published in:
- Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. - 2019
Liver Cancer
Mortality
NAFLD
OPTN
Transplant Waitlist
UNOS
Adolescent
Adult
Aged
Carcinoma, Hepatocellular
Cohort Studies
Female
Hepatitis B, Chronic
Hepatitis C, Chronic
Humans
Liver Cirrhosis, Alcoholic
Liver Neoplasms
Male
Middle Aged
Non-alcoholic Fatty Liver Disease
Prevalence
United States
Young Adult
English
BACKGROUND & AIMS
Although hepatitis B and C have been the main drivers of hepatocellular carcinoma (HCC), nonalcoholic steatohepatitis (NASH) has recently become an important cause of HCC. The aim of this study was to assess the causes of HCC among liver transplant (LT) candidates in the United States.
METHODS
The Scientific Registry of Transplant Recipients (2002-2016) was used to estimate the trends in prevalence of HCC in LT candidates with the most common types of chronic liver disease: alcoholic liver disease (ALD), chronic hepatitis B (CHB), chronic hepatitis C, and NASH.
RESULTS
158,347 adult LT candidates were included. Of these, 26,121 (16.5%) had HCC; this proportion increased from 6.4% (2002) to 23.0% (2016) (trend P < .0001). Over the study period, CHC remained the most common etiology for HCC (65%). The proportions of HCC accounted for by CHC and ALD remained stable (both trend P > .10), the proportion of CHB decreased 3.1-fold (P < .0001), while the proportion of NASH in HCC increased 7.7-fold (from 2.1% to 16.2%; P < .0001). Furthermore, since 2002, the prevalence of HCC in LT candidates with NASH increased 11.8-fold, while this rate increased 6.0-fold in CHB, 3.4-fold in ALD, and 2.3-fold in CHC (all P < .0001); the increasing trend in NASH was steeper than that for any other etiology (P < .0001 in a trend regression model). The proportion of LT candidates with HCC who ultimately received a transplant or died while waiting did not differ between etiologies (P > .05).
CONCLUSIONS
Nonalcoholic steatohepatitis is the most rapidly growing cause of HCC among US patients listed for liver transplantation.
Although hepatitis B and C have been the main drivers of hepatocellular carcinoma (HCC), nonalcoholic steatohepatitis (NASH) has recently become an important cause of HCC. The aim of this study was to assess the causes of HCC among liver transplant (LT) candidates in the United States.
METHODS
The Scientific Registry of Transplant Recipients (2002-2016) was used to estimate the trends in prevalence of HCC in LT candidates with the most common types of chronic liver disease: alcoholic liver disease (ALD), chronic hepatitis B (CHB), chronic hepatitis C, and NASH.
RESULTS
158,347 adult LT candidates were included. Of these, 26,121 (16.5%) had HCC; this proportion increased from 6.4% (2002) to 23.0% (2016) (trend P < .0001). Over the study period, CHC remained the most common etiology for HCC (65%). The proportions of HCC accounted for by CHC and ALD remained stable (both trend P > .10), the proportion of CHB decreased 3.1-fold (P < .0001), while the proportion of NASH in HCC increased 7.7-fold (from 2.1% to 16.2%; P < .0001). Furthermore, since 2002, the prevalence of HCC in LT candidates with NASH increased 11.8-fold, while this rate increased 6.0-fold in CHB, 3.4-fold in ALD, and 2.3-fold in CHC (all P < .0001); the increasing trend in NASH was steeper than that for any other etiology (P < .0001 in a trend regression model). The proportion of LT candidates with HCC who ultimately received a transplant or died while waiting did not differ between etiologies (P > .05).
CONCLUSIONS
Nonalcoholic steatohepatitis is the most rapidly growing cause of HCC among US patients listed for liver transplantation.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.cgh.2018.05.057
- PMID 29908364
- Persistent URL
- https://folia.unifr.ch/global/documents/76774
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