Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States.

By R. Wong, M. Aguilar, R. Cheung, R. Perumpail, S. Harrison, Z. Younossi, Aijaz Ahmed. Gastroenterology, 2015

1,723 citations recorded by the source corpus.

BACKGROUND & AIMS Nonalcoholic steatohepatitis (NASH) has been predicted to become the leading indication for liver transplantation (LT) in the United States. However, few studies have evaluated changes in the etiology of liver diseases among patients awaiting LT, and none have focused on the effects of NASH on liver transplant waitlists in the United States. METHODS We collected data from the United Network for Organ Sharing and Organ Procurement and Transplantation Network registry from 2004 through 2013, on liver transplant waitlist registrants with hepatitis C virus (HCV) infection, NASH, alcoholic liver disease (ALD), or a combination of HCV infection and ALD. We compared differences in survival within 90 days of registration (90-day survival) and probability of LT among patients with different diseases using Kaplan-Meier and multivariate logistic regression models. RESULTS Between 2004 and 2013, new waitlist registrants with NASH increased by 170% (from 804 to 2174), with ALD increased by 45% (from 1400 to 2024), and with HCV increased by 14% (from 2887 to 3291); registrants with HCV and ALD decreased by 9% (from 880 to 803). In 2013, NASH became the second-leading disease among liver transplant waitlist registrants, after HCV. Patients with ALD had a significantly higher mean Model for End-Stage Liver Disease score at time of waitlist registration than other registrants. However, after multivariate adjustment, patients with ALD were less likely to die within 90 days when compared with patients with NASH (odds ratio [OR] = 0.77; 95% confidence interval [CI]: 0.67-0.89; P < .001); patients with HCV infection or HCV and ALD had similar odds for 90-day survival compared with NASH patients. Compared with patients with NASH, patients with HCV (OR = 1.45; 95% CI: 1.35-1.55; P < .001), ALD (OR = 1.15; 95% CI: 1.06-1.24; P < .001), or HCV and ALD (OR = 1.29; 95% CI: 1.18-1.42; P < .001) had higher odds for 90-day survival. CONCLUSIONS Based on data from US adult LT databases, since 2004 the number of adults with NASH awaiting LTs has almost tripled. However, patients with NASH are less likely to undergo LT and less likely to survive for 90 days on the waitlist than patients with HCV, ALD, or HCV and ALD.

Subfields: Epidemiology, Hepatology, Pathology and Forensic Medicine

View Paper: https://www.semanticscholar.org/paper/859811ef50aa10d2185b77dd8c49876937b3360c

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In Epidemiology

1. Z. Younossi
2. M. Rinella
3. A. Sanyal
4. K. Cusi
5. R. Loomba
6. E. Brunt
7. J. Lavine
8. N. Chalasani

In Hepatology

1. Z. Younossi
2. M. Rinella
3. R. Loomba
4. K. Cusi
5. A. Sanyal
6. E. Brunt
7. C. Estes
8. H. Razavi

In Pathology and Forensic Medicine

1. Z. Younossi
2. A. Sanyal
3. M. Rinella
4. K. Cusi
5. E. Brunt
6. R. Loomba
7. S. Harrison
8. L. Henry

Citations in the corpus

• Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease (2017, background): “NASH is rapidly rising as an etiology of end stage liver disease, and is currently the second most common etiology of HCC requiring liver transplantation (8, 9).”
• The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases (2018, methodology): “Tapper et al. reported on the performance of VCTE in 164 patients with biopsy-proven NAFLD (median BMI, 32.2 kg/m2) from the United States.”
• Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A State-of-the-Art Review (2023, background): “24,25 The burden of MASLD and its complications, including HCC, is projected to continue to increase in the coming years.”
• Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases (2020, neutral): “(198,199) Furthermore, in the United States between 2004 and 2013, the number of new LT wait-list registrants with ALD increased by 45%, from 1400 to 2024.(200) The true denominator of patients with ALD who could potentially benefit from LT is unknown, so whether patients with ALD are underreferred ”
• Non-Alcoholic Fatty Liver Disease as a Nexus of Metabolic and Hepatic Diseases (2017, neutral): “And the prevalence of NASH in patients awaiting liver transplant has risen dramatically over the last decade, surpassing alcoholic liver disease and second only to chronic hepatitis C (Wong et al., 2015).”
• Global epidemiology of nonalcoholic fatty liver disease—Meta‐analytic assessment of prevalence, incidence, and outcomes (2016, background): “In this context, NASH has been recognized as one of the leading causes of cirrhosis in adults in the United States,((1-11)) and NASHrelated cirrhosis is currently the second indication for liver transplants in the United States.((8,9)) Clinically, NAFLD patients tend to be obese, with insulin resist”
• The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe (2016, methodology): “While remission was only allowed in the NAFL health state, regression was permitted from CC to FB, FB to no FB, and no FB to FB; therefore, patients could indirectly transition from these health states to the general population.((1-15,20-31)) Using this framework, the number of cases in each of the ”