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NASH expected to top indications for liver transplantation in HCC patients

Nonalcoholic steatohepatitis is the most rapidly progressing indication for liver transplantation among patients with hepatocellular carcinoma, a recent study determined.

In a retrospective study, researchers assessed trends in the etiology of hepatocellular carcinoma (HCC) among 61,868 patients who underwent liver transplantation (LT) in the US. The cohort, drawn from the 2002 to 2012 United Network for Organ Sharing registry, included 10,061 patients with HCC.

HCC patients who required LT reflected a growing trend that the researchers examined from 1995 to 2012, including a significant rise beginning in 2002 when the Model for End-stage Liver Disease (MELD) score was established. Proportions and patient numbers grew from 2.1% (1995) to 9.9% (2002) to 17.3% (2007) to 23.3% (2012).

At the same time, the proportion of HCC patients with hepatitis C virus (HCV) escalated during the study period (43.4%, 2002 vs. 49.9%, 2012; P<.001). By comparison, nonalcoholic steatohepatitis (NASH)-related HCC also grew (0%, 2002 vs. 6%, 2012; P<.001), and NASH-related HCC patients who underwent LT nearly quadrupled, while LT patients with HCV-related HCC doubled during the study period.

“The increasing prevalence of obesity and obesity-related diseases is a major public health concern, and NASH will soon become the leading indication for LT and the leading etiology of HCC in the US,” researchers from Stanford University School of Medicine, division of gastroenterology and hepatology, reported. “During the MELD era, HCV remains the leading etiology of HCC among LT recipients. However, the prevalence of NASH-related HCC has increased nearly fourfold … and NASH has become the second-leading etiology of HCC among LT recipients since 2006.”

Disclosure: The researchers report no relevant financial disclosures.