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HCV decreasing while NASH, ALD increasing among LT patients

The percentage of patients on the liver transplant waitlist or undergoing liver transplantation for chronic hepatitis C virus infection has significantly dropped since 2003, while the proportions of patients on the waitlist or undergoing transplantation for nonalcoholic steatohepatitis or alcoholic liver disease have increased, according to new research.

Aiming to determine changes in the burden of liver disease over time in the U.S. population, David Goldberg, MD, MSCE, of the Perelman School of Medicine at the University of Pennsylvania, and colleagues compared data from liver transplantation waitlists with disease prevalence data spanning 2003 through 2015.

David Goldberg

First, they found that data from the National Health and Nutrition Examination Survey (n = 8,291) showed the proportion of patients with a positive HCV antibody test and a positive HCV RNA was 0.5 (95% CI, 0.42-0.55) in 2013-2014, which was significantly lower compared with 2010 (0.64; 95% CI, 0.59-0.73; P = .03).

Additionally, data from the HealthCore Integrated Research Database (n = 41,082) showed that from 2006 through 2014, the proportion of patients with compensated cirrhosis from HCV or alcoholic liver disease decreased significantly (both P < .05), while the proportion of patients with cirrhosis from nonalcoholic steatohepatitis increased significantly (P < .05).

HealthCore data also showed the proportion of patients with chronic liver failure from HCV or ALD decreased significantly (P < .05), while the proportion of patients with chronic liver failure from NASH increased by almost threefold (P < .05). Moreover, the same data showed the proportion of patients with hepatocellular carcinoma from HCV or ALD decreased significantly (P < .05), while there was a small increase in HCC among patients with NASH.

Finally, data from the United Network for Organ Sharing showed that from 2003 through 2015, the proportion of patients with HCV decreased significantly among patients new to the liver transplant waitlist or those undergoing liver transplantation for chronic liver failure. During the same period, the data showed a significant increase in the proportions of these patients with nonalcoholic fatty liver disease or ALD. Finally, these data showed the prevalence of HCV, NAFLD or ALD was unchanged among patients new to the waitlist or undergoing transplantation for HCC.

“Chronic HCV seems to be decreasing with the advent of new therapies, which is manifesting as a lower burden of cirrhosis and chronic liver failure among waitlist additions and new transplant recipients,” the researchers concluded. “At the same time, NASH and ALD are becoming relatively more common among waitlisted patients and transplant recipients, despite different relative burdens of disease in the broader cirrhotic population.” – by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.