Zobair Younossi1, Maria Stepanova2, Janus P Ong3, Ira M Jacobson4, Elisabetta Bugianesi5, Ajay Duseja6, Yuichiro Eguchi7, Vincent W Wong8, Francesco Negro9, Yusuf Yilmaz10, Manuel Romero-Gomez11, Jacob George12, Aijaz Ahmed13, Robert Wong14, Issah Younossi2, Mariam Ziayee2, Arian Afendy2. 1. Center for Liver Diseases, Department of Medicine, Inova Health System, Falls Church, Virginia; Division of Gastroenterology and Hepatology, Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia. Electronic address: zobair.younossi@inova.org. 2. Center for Outcomes Research in Liver Disease, Washington, District of Columbia. 3. Department of Medicine, University of Philippines, Manila, Philippines. 4. Division of Gastroenterology and Hepatology, New York University School of Medicine, New York, New York. 5. Division of Gastroenterology, Department of Medical Sciences, University of Torino, Torino, Italy. 6. Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 7. Liver Center, Saga University Hospital, Saga, Japan. 8. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China. 9. Division of Gastroenterology and Hepatology, University of Geneva, Geneva, Switzerland. 10. Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey. 11. Digestive Diseases Unit, Virgin del Rocio University Hospital, Sevilla, Spain. 12. Sorr Liver Centre, The Westmead Institute of Medical Research, University of Sydney, Westmead Hospital, Sydney, Australia. 13. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California. 14. Division of Gastroenterology and Hepatology, Alameda Health System, Oakland, California.
Abstract
BACKGROUND & AIMS: Although hepatitis B and C have been the main drivers of hepatocellular carcinoma (HCC), nonalcoholic steatohepatitis (NASH) has recently become an important cause of HCC. The aim of this study was to assess the causes of HCC among liver transplant (LT) candidates in the United States. METHODS: The Scientific Registry of Transplant Recipients (2002-2016) was used to estimate the trends in prevalence of HCC in LT candidates with the most common types of chronic liver disease: alcoholic liver disease (ALD), chronic hepatitis B (CHB), chronic hepatitis C, and NASH. RESULTS: 158,347 adult LT candidates were included. Of these, 26,121 (16.5%) had HCC; this proportion increased from 6.4% (2002) to 23.0% (2016) (trend P < .0001). Over the study period, CHC remained the most common etiology for HCC (65%). The proportions of HCC accounted for by CHC and ALD remained stable (both trend P > .10), the proportion of CHB decreased 3.1-fold (P < .0001), while the proportion of NASH in HCC increased 7.7-fold (from 2.1% to 16.2%; P < .0001). Furthermore, since 2002, the prevalence of HCC in LT candidates with NASH increased 11.8-fold, while this rate increased 6.0-fold in CHB, 3.4-fold in ALD, and 2.3-fold in CHC (all P < .0001); the increasing trend in NASH was steeper than that for any other etiology (P < .0001 in a trend regression model). The proportion of LT candidates with HCC who ultimately received a transplant or died while waiting did not differ between etiologies (P > .05). CONCLUSIONS: Nonalcoholic steatohepatitis is the most rapidly growing cause of HCC among US patients listed for liver transplantation.
BACKGROUND & AIMS: Although hepatitis B and C have been the main drivers of hepatocellular carcinoma (HCC), nonalcoholic steatohepatitis (NASH) has recently become an important cause of HCC. The aim of this study was to assess the causes of HCC among liver transplant (LT) candidates in the United States. METHODS: The Scientific Registry of Transplant Recipients (2002-2016) was used to estimate the trends in prevalence of HCC in LT candidates with the most common types of chronic liver disease: alcoholic liver disease (ALD), chronic hepatitis B (CHB), chronic hepatitis C, and NASH. RESULTS: 158,347 adult LT candidates were included. Of these, 26,121 (16.5%) had HCC; this proportion increased from 6.4% (2002) to 23.0% (2016) (trend P < .0001). Over the study period, CHC remained the most common etiology for HCC (65%). The proportions of HCC accounted for by CHC and ALD remained stable (both trend P > .10), the proportion of CHB decreased 3.1-fold (P < .0001), while the proportion of NASH in HCC increased 7.7-fold (from 2.1% to 16.2%; P < .0001). Furthermore, since 2002, the prevalence of HCC in LT candidates with NASH increased 11.8-fold, while this rate increased 6.0-fold in CHB, 3.4-fold in ALD, and 2.3-fold in CHC (all P < .0001); the increasing trend in NASH was steeper than that for any other etiology (P < .0001 in a trend regression model). The proportion of LT candidates with HCC who ultimately received a transplant or died while waiting did not differ between etiologies (P > .05). CONCLUSIONS:Nonalcoholic steatohepatitis is the most rapidly growing cause of HCC among US patients listed for liver transplantation.
Authors: Annika Nerstedt; Yeshwant Kurhe; Emmelie Cansby; Mara Caputo; Lei Gao; Egor Vorontsov; Marcus Ståhlman; Esther Nuñez-Durán; Jan Borén; Hanns-Ulrich Marschall; Douglas G Mashek; Darren N Saunders; Carina Sihlbom; Andrew J Hoy; Margit Mahlapuu Journal: J Lipid Res Date: 2019-12-19 Impact factor: 5.922