Liver transplantation for NASH on the rise in the USA

Liver transplantation for NASH on the rise in the USA
By MedWire Reporters 05 August 2011
Gastroenterology 2011; Advance online publicationMedWire News:

Liver transplantation for nonalcoholic steatohepatitis (NASH) is increasing in the USA, research shows.

NASH is currently the third most common indication for liver transplantation, and may soon become the most common reason patients require a new liver, report Michael Charlton (Mayo Clinic, Rochester, Minnesota) and colleagues in the journal Gastroenterology.

The prevalence of non-alcoholic fatty liver disease (NAFLD) and NASH are increasing worldwide, corresponding to the rising global prevalence of obesity, they add. However, it is not known whether the increasing rate of NASH contributes to changing indications for liver transplantation.

In the present analysis of a large US registry of transplant recipients, the researchers identified 35,781 patients who underwent primary liver transplantation between 2001 and 2009.

Of these, NASH was the primary or secondary indication for transplantation in 1959 patients.

The researchers report that the percentage of patients undergoing liver transplantation for NASH increased from 1.2% in 2001 to 9.7% in 2009.

They add that when the 119 cases where NASH was listed as the secondary indication were excluded from the analysis, the frequency of liver transplantation for NASH still increased, from 1.0% in 2001 to 8.5% in 2009.

These findings confirm that "NASH is an increasingly important cause of end-stage liver disease and is already placing a substantial burden on an overstretched donor organ supply," say Charlton et al.

Compared with other indications for transplantation, patients with NASH were older had a higher body mass index, were more likely to be female, and less likely to have hepatocellular carcinoma.

Survival rates for patients with NASH undergoing liver transplantation at one and three years were 84% and 78%, respectively, writes the team. These rates were not significantly different when compared with patients undergoing liver transplantation for other indications, however.

The researchers note that NASH is currently the third most common indication for liver transplantation, but is the only indication consistently increasing in frequency.

They conclude, therefore, that the increase in NASH, as well as the decline in hepatitis C virus as an indication for transplantation, suggests that NASH may become the most common indication for liver transplantation between 2020 and 2025.

MedWire (www.medwire-news.md ) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

Free abstract