Wednesday, September 27, 2017

Rising Rates of Hepatocellular Carcinoma Leading to Liver Transplantation in Baby Boomer Generation with Chronic Hepatitis C

Rising Rates of Hepatocellular Carcinoma Leading to Liver Transplantation in Baby Boomer Generation with Chronic Hepatitis C, Alcohol Liver Disease, and Nonalcoholic Steatohepatitis-Related Liver Disease
George Cholankeril 1, Eric R. Yoo 2, Ryan B. Perumpail 3, Andy Liu 4, Jeevin S. Sandhu 1, Satheesh Nair 5, Menghan Hu 6 and Aijaz Ahmed 1,*

Received: 28 August 2017 / Accepted: 25 September 2017 / Published: 26 September 2017

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Abstract
We aim to study the impact of the baby boomer (BB) generation, a birth-specific cohort (born 1945–1965) on hepatocellular carcinoma (HCC)-related liver transplantation (LT) in patients with chronic hepatitis C virus (HCV), alcoholic liver disease (ALD), and non-alcoholic steatohepatitis (NASH). We performed a retrospective analysis using the United Network for Organ Sharing (UNOS)/Organ Procurement Transplant Network (OPTN) database from 2003 to 2014 to compare HCC-related liver transplant surgery trends between two cohorts—the BB and non-BB—with a secondary diagnosis of HCV, ALD, or NASH. From 2003–2014, there were a total of 8313 liver transplant recipients for the indication of HCC secondary to HCV, ALD, or NASH. Of the total, 6658 (80.1%) HCC-related liver transplant recipients were BB. The number of liver transplant surgeries for the indication of HCC increased significantly in NASH (+1327%), HCV (+382%), and ALD (+286%) during the study period. The proportion of BB who underwent LT for HCC was the highest in HCV (84.7%), followed by NASH (70.3%) and ALD (64.7%). The recommendations for birth-cohort specific HCV screening stemmed from a greater understanding of the high prevalence of chronic HCV and HCV-related HCC within BB. The rising number of HCC-related LT among BB with ALD and NASH suggests the need for increased awareness and improved preventative screening/surveillance measures within NASH and ALD cohorts as well.

Table 1. Baby Boomer HCC Liver Transplantation Annual Trends with HCV, ALD, and NASH; UNOS 2003–2014.
HCVNASHALD
BB OverallPercentBBOverallPercentBBOverallPercent
200314921669.0%111957.9%223759.5%
200416722474.6%203852.6%163348.5%
200521829773.4%224746.8%285947.5%
200627135177.2%377152.1%367548.0%
200737346180.9%549060.0%388544.7%
200842750584.6%8012464.5%487960.8%
200946054085.2%9615163.6%567673.7%
201049258584.1%10113276.5%456668.2%
201156763289.7%9112871.1%8110775.7%
201261970787.6%12716875.6%7710672.6%
201364672289.5%15319180.1%699275.0%
201471979490.6%15719182.2%8511474.6%
Total5108603484.7%949135070.3%60192964.7%
APC +2.6%+3.5%+2.1%
BB = Baby Boomer; APC = Annual Percent Change.


Table 2. Demographic and Clinical Characteristics in HCC Liver Transplant Recipients among Baby Boomers versus Non-Baby Boomers; UNOS 2003–2014.
HCVNASHALD
BB
n = 5108
Non-BB
n = 926
pBB
n = 949
Non-BB
n = 401
pBB
n = 601
Non-BB
n = 328
p
Age, median5766<0.015967<0.015867<0.01
Gender
 Male80.3%66.1%<0.0173.0%65.1%<0.0190.5%89.6%0.67
Ethnicity
 White67.7%59.1%<0.0175.9%77.6%0.5069.6%78.7%<0.01
 Black13.3%11.1%0.075.4%3.7%0.203.8%1.2%0.02
 Hispanic13.6%17.6%<0.0114.7%14.5%0.9314.7%14.5%0.14
 Asian4.1%11.1%<0.012.6%2.2%0.673.0%1.2%0.89
 Other9.9%1.1%<0.011.4%2.0%0.498.9%4.4%<0.05
HE40.2%34.8%<0.0143.4%41.4%<0.5050.3%43.9%0.09
Diabetes23.6%28.4%<0.0147.7%47.7%<0.0135.1%33.5%0.63
Ascites50.9%46.8%<0.0555.2%55.2%0.8468.6%62.5%0.06

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