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.

	HCV			NASH			ALD
	BB †	Overall	Percent	BB	Overall	Percent	BB	Overall	Percent
2003	149	216	69.0%	11	19	57.9%	22	37	59.5%
2004	167	224	74.6%	20	38	52.6%	16	33	48.5%
2005	218	297	73.4%	22	47	46.8%	28	59	47.5%
2006	271	351	77.2%	37	71	52.1%	36	75	48.0%
2007	373	461	80.9%	54	90	60.0%	38	85	44.7%
2008	427	505	84.6%	80	124	64.5%	48	79	60.8%
2009	460	540	85.2%	96	151	63.6%	56	76	73.7%
2010	492	585	84.1%	101	132	76.5%	45	66	68.2%
2011	567	632	89.7%	91	128	71.1%	81	107	75.7%
2012	619	707	87.6%	127	168	75.6%	77	106	72.6%
2013	646	722	89.5%	153	191	80.1%	69	92	75.0%
2014	719	794	90.6%	157	191	82.2%	85	114	74.6%
Total	5108	6034	84.7%	949	1350	70.3%	601	929	64.7%
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.

	HCV			NASH			ALD
	BB n = 5108	Non-BB n = 926	p	BB n = 949	Non-BB n = 401	p	BB n = 601	Non-BB n = 328	p
Age, median	57	66	<0.01	59	67	<0.01	58	67	<0.01
Gender
Male	80.3%	66.1%	<0.01	73.0%	65.1%	<0.01	90.5%	89.6%	0.67
Ethnicity
White	67.7%	59.1%	<0.01	75.9%	77.6%	0.50	69.6%	78.7%	<0.01
Black	13.3%	11.1%	0.07	5.4%	3.7%	0.20	3.8%	1.2%	0.02
Hispanic	13.6%	17.6%	<0.01	14.7%	14.5%	0.93	14.7%	14.5%	0.14
Asian	4.1%	11.1%	<0.01	2.6%	2.2%	0.67	3.0%	1.2%	0.89
Other	9.9%	1.1%	<0.01	1.4%	2.0%	0.49	8.9%	4.4%	<0.05
HE	40.2%	34.8%	<0.01	43.4%	41.4%	<0.50	50.3%	43.9%	0.09
Diabetes	23.6%	28.4%	<0.01	47.7%	47.7%	<0.01	35.1%	33.5%	0.63
Ascites	50.9%	46.8%	<0.05	55.2%	55.2%	0.84	68.6%	62.5%	0.06

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