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NASH may soon become most common liver transplant etiology

Results of a recent study showed that nonalcoholic steatohepatitis was the most rapidly growing cause of hepatocellular carcinoma among U.S. patients listed for liver transplantation.

“The prevalence of HCC seems to be growing at a significantly higher pace for the waitlisted patients with NASH as compared to the other common causes of chronic liver disease,” Zobair M. Younossi, MD, from the Inova Fairfax Hospital in Virginia, and colleagues wrote. “It is plausible that patients with NASH may actually present late in the course of their disease with more advanced liver disease and higher stage HCC, both of which can potentially affect their status on the transplant list and their post-LT outcomes.”

Younossi and colleagues accessed data from the Scientific Registry of Transplant Recipients, which includes all donor, waitlist candidates and transplant recipients in the U.S. from the Organ Procurement and Transplantation Network.

Of those listed between 2002 and 2017, the researchers found 28,935 with a diagnosis of HCC and an etiology of chronic hepatitis B (7%), chronic hepatitis C (55.9%), NASH (11%), alcoholic liver disease (10.3%) or ALD with HCV.

From 2002 to 2016, the prevalence of HCC increased 2.4-fold in patients with chronic HBV, 6.2-fold in chronic HCV, 3.1-fold in alcoholic liver disease, 6.4-fold in those with ALD and chronic HCV, and 11.5-fold in NASH.

While prevalence of HCC in NASH varied between clinical populations, the researchers observed a significant increase across all sex and age groups and regardless of type 2 diabetes status (P < .0005).

During the study period, chronic HCV remained the most common etiology for HCC in waitlisted candidates and rates remained stable among patients with ALD and combined ALD and chronic HCV. In contrast, NASH in HCC increased 8.5-fold from 2.1% in 2002 to 17.9% in 2017 (P < .0001) and the proportion of chronic HBV in HCC decreased 2.9-fold from 14.3% in 2002 to 4.9% in 2017 (P < .0001).

“Our data clearly show that ... the highest rate of [increased HCC] is seen in waitlisted patients with NASH,” the researchers concluded. “Although [chronic HCV (CHC)] currently remains the most common etiology for HCC in transplant candidates and recipients, as more CHC patients are being cured with new highly-effective antiviral regimens, NASH may become the top etiology not only for cirrhotics but also for HCC in patients listed for liver transplantation.” – by Talitha Bennett

Disclosure: Younossi reports he is a consultant to AbbVie, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline and Intercept Pharmaceuticals. Please see the full study for the other authors’ relevant financial disclosures.