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Transplantation. 2018 Nov 16. doi: 10.1097/TP.0000000000002497. [Epub ahead of print]

Future Trends in Demand for Liver Transplant: Birth-Cohort Effects among Patients with NASH and HCC.

Author information

1
University of Washington, Division of Gastroenterology and Hepatology, Liver Care Line.
2
Center for Liver Investigation Fostering discovEry (C-LIFE), University of Washington.
3
University of Colorado Anschutz Medical Campus, Department of Radiology.
4
University of California San Francisco, Department of Transplant Surgery.
5
University of Colorado Anschutz Medical Campus, Departments of Pediatrics and Biostatistics & Informatics.
6
Section of Gastroenterology, The Vancouver Clinic, Vancouver, Washington.

Abstract

BACKGROUND:

With increasing U.S. adiposity, NASH is now a leading liver transplant (LT) indication. Given its association with hepatocellular carcinoma (HCC), the burden of NASH is substantial. We analyzed birth-cohort effects among NASH LT registrants, with and without HCC.

METHODS:

All new LT registrants in UNOS (1995-2015) were identified. Birth-cohorts were: 1936-1940, 1941-1945, 1946-1950, 1951-1955, 1956-1960, 1961-1965, 1966-1970, 1971-2015. Poisson regression examined trends in LT registration, by disease etiology (NASH, HCV, OTHER), and HCC.

RESULTS:

We identified 182,368 LT registrants with median age 52 years (range 0-86). Nine-percent (n=16,160) had NASH, 38% (n=69,004) HCV, 53% (n=97,204) OTHER. HCC was present in: 13% (n=2,181), 27% (n=18,295), and 11% (n=10,902), of NASH, HCV, and OTHER, respectively. LT registration for HCC increased significantly from 2002-2015 across all etiologies (NASH 6%➔18%; HCV 19%➔51%; OTHER 9%➔16%, p<0.0001 for all). NASH LT registrations, with and without HCC, increased sharply in patients born from 1945-2015. This upward NASH trend is in stark contrast to HCV LT registrations, which showed a general decline. Notably, a sharp rise in LT registrations is among younger NASH patients (35-55 years), mirroring the increasing adiposity across all age groups in the U.S.

POPULATION:

CONCLUSIONS:

NASH LT registrants, with and without HCC, increased over time, and are projected to increase unabated in the future, notably among younger birth-cohorts ("Adipose Wave Effect"). HCC LT registration patterns demonstrate that, compared to HCV, NASH patients encompass younger birth-cohorts. These data illustrate that the full impact of NASH on demand for LT is yet to be realized.

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