MASH now top indication for liver transplantation in those with hepatocellular carcinoma

Key takeaways:

• Alcoholic liver disease and MASH were the most common indications for liver transplantation in candidates without HCC.
• MASH rapidly increased from 20% in 2018 to 31% in 2022 among LT candidates with HCC.

BOSTON — Metabolic dysfunction-associated steatohepatitis is currently the most common indication for liver transplantation in patients with hepatocellular carcinoma, increasing from 10% in 2013 to 31% in 2022, according to a presenter.

“Given the availability of highly effective treatments for HBV and HCV, our feeling was that the profile of patients listed for LT in the United States is changing,” Zobair M. Younossi, MD, MPH, professor and chairman of the department of medicine at Inova Fairfax Medical Campus, told Healio. “Our data provided evidence that this is true, and MASH is now the most common indication for LT for patients with HCC.”

To determine the latest trends in patients with chronic liver disease listed for LT, Younossi and colleagues used the Scientific Registry of Transplant Recipients to identify adult candidates between 2013 and 2022. Researchers used primary and secondary etiologies to determine the most common for chronic liver disease.

According to results presented at The Liver Meeting, Younossi and colleagues identified 116,292 LT candidates with a known etiology of chronic liver disease. Among those without HCC, alcoholic liver disease was the most common etiology, which increased from 23% to 48% between 2013 and 2022; the most rapid increase occurred between 2019 to 2022 (38% to 48%). MASH, formerly known as NASH, was the second most common indication for LT in candidates without HCC, with an increase from 19% to 27% in the studied timeframe.

Conversely, Younossi and colleagues reported a decrease in rates of chronic hepatitis C virus infection, from 28% to 4%, and chronic hepatitis B virus infection, from 1.8% to 1.1%.

Although cumulatively 21% (n = 24,657) of LT candidates had HCC, the proportion decreased from around 25% to 17%, as did chronic HCV (60% to 27%). However, MASH increased from 10% to 31% and alcoholic liver disease from 9% to 24%. Chronic HBV remained stable in this population (5% to 7%).

Researchers also reported that among those with HCC, the proportion of patients with MASH has continued to rapidly increase, from 20% in 2018 to 31% 2022, a trend that sustained significance after adjusting for candidates’ age, sex, ethnicity, obesity and type 2 diabetes.

“The study suggests that burden of liver disease related to MASH is growing in the U.S.,” Younossi told Healio. “This indicates that we need to place more attention in the clinic to perform recommended HCC screenings for patients with MASH.”