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NASH surpasses HCV as top etiology for adults listed for liver transplant
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LAS VEGAS — Nonalcoholic steatohepatitis is the number one etiology of liver disease among adults under the age of 50 years listed for liver transplantation, surpassing hepatitis C virus infection, according to findings presented at ACG 2016.
“Nonalcoholic fatty liver disease, considered the hepatic manifestation of the metabolic syndrome, affects up to 10% of the pediatric population and 30% of adults in North America. The NAFLD incidence has been rising and the most common cause of chronic liver disease in children,” Bubu A. Banini, MD, PhD, of Virginia Commonwealth University, said during her presentation in a liver plenary session. “We hypothesized that if NAFLD is progressive in children and young adults, one would expect to see an increase in the number of adults under the age of 50 years who develop NAFLD-related end-stage liver disease requiring listing for liver transplantation.”
Banini and colleagues extracted data of adults listed for transplant between 2002 and 2015 from the United Network for Organ Sharing registry. The adults were divided into groups based on age and researchers determined the primary etiology of end-stage liver disease by year.
The overall number of adults listed for transplant decreased from 1,776 in 2002 to 704 in 2014. Between 2002 and 2014, NASH and cryptogenic cirrhosis etiologies for liver disease increased by 124% compared with HCV decreasing by 78% (P < .0001).
Adults between the ages of 18 and 34 years with a liver disease etiology of NASH or cryptogenic cirrhosis remained the same, whereas there was an increase in the number of adults between the ages of 35 and 49 years, listed with the same etiologies.
For 2015, NASH and cryptogenic cirrhosis surpassed HCV as the leading etiology for liver transplant for adults between the ages of 35 and 49 years (194 vs. 148). This was also observed in adults older than 50 years of age. Data was available through August of 2015, according to Banini, and they are waiting for data from the rest of 2015 for further analysis.
“Given the 20- to 30-year time frame for development of cirrhosis due to NAFLD, this suggests that NAFLD in pediatric age groups and young adults is a significant public health problem,” Banini said. “Our results support screening for NAFLD in high-risk pediatric populations to avoid progression to end-stage liver disease.” – by Melinda Stevens
Reference:
Banini BA, et al. Abstract #46. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 14-19, 2016; Las Vegas, NV.
Disclosure: Banini reports no relevant financial disclosures.
Perspective
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Dina Halegoua-De Marzio, MD
Despite major gains in fighting hepatitis B, hepatitis C and other chronic liver conditions, clinicians are now faced with a growing epidemic of liver disease that is linked to the obesity epidemic. Data has shown that over the past two decades, the prevalence nonalcoholic fatty liver disease and its more severe form nonalcoholic steatohepatitis, has doubled in teenagers and young adults, and climbed at a similar rate in adults. Previous studies have projected that NASH would surpass hepatitis C as the leading cause of liver transplants by 2020, in part because of new drugs that can effectively cure hepatitis C, but also because of the rapid growth of NAFLD.
This study provides data from United Network for Organ Sharing registry that, in 2016, NASH may already be the most common indication for liver transplant in patients under the age 50. One major limitation of the study is that it included patients with cryptogenic cirrhosis in the NASH cirrhosis analysis, which may have falsely elevated the percentages. Despite this, the prevalence of the disease is clearly rising at a rapid rate. It is important to remember just 3 decades ago, NASH was so rare that there was no medical name for it. This study and others like it, should be a wake-up call for all clinicians and patients. Clinicians need to face the obesity crisis head on especially in our youth who are most at risk from complications from this disease 20 to 30 years after diagnosis. More education needs to be provided to the public about the risk of this disease and the potential complications if left untreated.
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