Nonalcoholic Steatohepatitis Is the Fastest Growing Cause of Hepatocellular Carcinoma in Liver Transplant Candidates - PubMed (original) (raw)

. 2019 Mar;17(4):748-755.e3.

doi: 10.1016/j.cgh.2018.05.057. Epub 2018 Jun 14.

Maria Stepanova 2, Janus P Ong 3, Ira M Jacobson 4, Elisabetta Bugianesi 5, Ajay Duseja 6, Yuichiro Eguchi 7, Vincent W Wong 8, Francesco Negro 9, Yusuf Yilmaz 10, Manuel Romero-Gomez 11, Jacob George 12, Aijaz Ahmed 13, Robert Wong 14, Issah Younossi 2, Mariam Ziayee 2, Arian Afendy 2; Global Nonalcoholic Steatohepatitis Council

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Nonalcoholic Steatohepatitis Is the Fastest Growing Cause of Hepatocellular Carcinoma in Liver Transplant Candidates

Zobair Younossi et al. Clin Gastroenterol Hepatol. 2019 Mar.

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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.

Keywords: Liver Cancer; Mortality; NAFLD; OPTN; Transplant Waitlist; UNOS.

Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.

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