Increasing Incidence of Nonalcoholic Steatohepatitis as an Indication for Liver Transplantation in Australia and New Zealand

Luis Calzadilla-Bertot, Gary P. Jeffrey, Bryon Jacques, Geoffrey McCaughan, Michael Crawford, Peter Angus, Robert Jones, Edward Gane, Stephen Munn, Graeme Macdonald, Jonathan Fawcett, Alan Wigg, John Chen, Michael Fink, Leon A. Adams

Research output: Contribution to journalArticle

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Abstract

The worldwide increase in obesity and diabetes has led to predictions that nonalcoholic steatohepatitis (NASH) will become the leading indication for orthotopic liver transplantation (OLT). Data supporting this prediction from outside the United States are limited. Thus, we aimed to determine trends in the frequency of NASH among adults listed and undergoing OLT in Australia and New Zealand (ANZ) from 1994 to 2017. Data from the ANZ Liver Transplant Registry were analyzed with patients listed for fulminant liver failure, retransplantation, or multivisceral transplants excluded. Nonparametric trend, Spearman rank correlation, and regression analysis were used to assess trends in etiologies of liver disease over time. Of 5016 patient wait-list registrants, a total of 3470 received an OLT. The percentage of patients with NASH activated for OLT increased significantly from 2.0% in 2003 to 10.9% in 2017 (trend analyses; P <0.001). In 2017, NASH was the third leading cause of chronic liver disease (CLD) among wait-list registrants behind chronic hepatitis C virus (HCV; 29.5%) and alcohol (16.1%). Similarly, significant increases over time in the percentage of patients undergoing OLT were observed for HCV and NASH (all trend analyses; P <0.001) but with significant reductions in primary sclerosing cholangitis and cryptogenic cirrhosis (both P <0.05). By 2017, NASH was the third leading cause of liver disease among patients undergoing OLT (12.4%) and behind chronic HCV (30.2%) and alcohol (18.2%). NASH also became the third most frequent etiology of CLD in patients transplanted (13.8%) with concomitant hepatocellular carcinoma by 2017. In conclusion, NASH is increasing as a primary etiology of liver disease requiring listing and liver transplantation in ANZ.

Original languageEnglish
Pages (from-to)25-34
Number of pages10
JournalLiver Transplantation
Volume25
Issue number1
DOIs
Publication statusPublished - Jan 2019

Cite this

Calzadilla-Bertot, Luis ; Jeffrey, Gary P. ; Jacques, Bryon ; McCaughan, Geoffrey ; Crawford, Michael ; Angus, Peter ; Jones, Robert ; Gane, Edward ; Munn, Stephen ; Macdonald, Graeme ; Fawcett, Jonathan ; Wigg, Alan ; Chen, John ; Fink, Michael ; Adams, Leon A. / Increasing Incidence of Nonalcoholic Steatohepatitis as an Indication for Liver Transplantation in Australia and New Zealand. In: Liver Transplantation. 2019 ; Vol. 25, No. 1. pp. 25-34.
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abstract = "The worldwide increase in obesity and diabetes has led to predictions that nonalcoholic steatohepatitis (NASH) will become the leading indication for orthotopic liver transplantation (OLT). Data supporting this prediction from outside the United States are limited. Thus, we aimed to determine trends in the frequency of NASH among adults listed and undergoing OLT in Australia and New Zealand (ANZ) from 1994 to 2017. Data from the ANZ Liver Transplant Registry were analyzed with patients listed for fulminant liver failure, retransplantation, or multivisceral transplants excluded. Nonparametric trend, Spearman rank correlation, and regression analysis were used to assess trends in etiologies of liver disease over time. Of 5016 patient wait-list registrants, a total of 3470 received an OLT. The percentage of patients with NASH activated for OLT increased significantly from 2.0{\%} in 2003 to 10.9{\%} in 2017 (trend analyses; P <0.001). In 2017, NASH was the third leading cause of chronic liver disease (CLD) among wait-list registrants behind chronic hepatitis C virus (HCV; 29.5{\%}) and alcohol (16.1{\%}). Similarly, significant increases over time in the percentage of patients undergoing OLT were observed for HCV and NASH (all trend analyses; P <0.001) but with significant reductions in primary sclerosing cholangitis and cryptogenic cirrhosis (both P <0.05). By 2017, NASH was the third leading cause of liver disease among patients undergoing OLT (12.4{\%}) and behind chronic HCV (30.2{\%}) and alcohol (18.2{\%}). NASH also became the third most frequent etiology of CLD in patients transplanted (13.8{\%}) with concomitant hepatocellular carcinoma by 2017. In conclusion, NASH is increasing as a primary etiology of liver disease requiring listing and liver transplantation in ANZ.",
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Calzadilla-Bertot, L, Jeffrey, GP, Jacques, B, McCaughan, G, Crawford, M, Angus, P, Jones, R, Gane, E, Munn, S, Macdonald, G, Fawcett, J, Wigg, A, Chen, J, Fink, M & Adams, LA 2019, 'Increasing Incidence of Nonalcoholic Steatohepatitis as an Indication for Liver Transplantation in Australia and New Zealand' Liver Transplantation, vol. 25, no. 1, pp. 25-34. https://doi.org/10.1002/lt.25361

Increasing Incidence of Nonalcoholic Steatohepatitis as an Indication for Liver Transplantation in Australia and New Zealand. / Calzadilla-Bertot, Luis; Jeffrey, Gary P.; Jacques, Bryon; McCaughan, Geoffrey; Crawford, Michael; Angus, Peter; Jones, Robert; Gane, Edward; Munn, Stephen; Macdonald, Graeme; Fawcett, Jonathan; Wigg, Alan; Chen, John; Fink, Michael; Adams, Leon A.

In: Liver Transplantation, Vol. 25, No. 1, 01.2019, p. 25-34.

Research output: Contribution to journalArticle

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AU - Calzadilla-Bertot, Luis

AU - Jeffrey, Gary P.

AU - Jacques, Bryon

AU - McCaughan, Geoffrey

AU - Crawford, Michael

AU - Angus, Peter

AU - Jones, Robert

AU - Gane, Edward

AU - Munn, Stephen

AU - Macdonald, Graeme

AU - Fawcett, Jonathan

AU - Wigg, Alan

AU - Chen, John

AU - Fink, Michael

AU - Adams, Leon A.

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AB - The worldwide increase in obesity and diabetes has led to predictions that nonalcoholic steatohepatitis (NASH) will become the leading indication for orthotopic liver transplantation (OLT). Data supporting this prediction from outside the United States are limited. Thus, we aimed to determine trends in the frequency of NASH among adults listed and undergoing OLT in Australia and New Zealand (ANZ) from 1994 to 2017. Data from the ANZ Liver Transplant Registry were analyzed with patients listed for fulminant liver failure, retransplantation, or multivisceral transplants excluded. Nonparametric trend, Spearman rank correlation, and regression analysis were used to assess trends in etiologies of liver disease over time. Of 5016 patient wait-list registrants, a total of 3470 received an OLT. The percentage of patients with NASH activated for OLT increased significantly from 2.0% in 2003 to 10.9% in 2017 (trend analyses; P <0.001). In 2017, NASH was the third leading cause of chronic liver disease (CLD) among wait-list registrants behind chronic hepatitis C virus (HCV; 29.5%) and alcohol (16.1%). Similarly, significant increases over time in the percentage of patients undergoing OLT were observed for HCV and NASH (all trend analyses; P <0.001) but with significant reductions in primary sclerosing cholangitis and cryptogenic cirrhosis (both P <0.05). By 2017, NASH was the third leading cause of liver disease among patients undergoing OLT (12.4%) and behind chronic HCV (30.2%) and alcohol (18.2%). NASH also became the third most frequent etiology of CLD in patients transplanted (13.8%) with concomitant hepatocellular carcinoma by 2017. In conclusion, NASH is increasing as a primary etiology of liver disease requiring listing and liver transplantation in ANZ.

KW - FATTY LIVER

KW - HEPATITIS-C

KW - DISEASE

KW - CIRRHOSIS

KW - PREVALENCE

KW - OUTCOMES

KW - ETIOLOGY

KW - FIBROSIS

KW - THERAPY

KW - IMPACT

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DO - 10.1002/lt.25361

M3 - Article

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EP - 34

JO - Liver Transplantation

JF - Liver Transplantation

SN - 1074-3022

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