In the era of highly effective treatments for hepatitis C virus, alcoholic liver disease (ALD) has overtaken HCV as the primary driver of liver transplantation in the United States.
Findings from two studies examining the causes of liver transplantation were presented at the 52nd International Liver Congress in Paris.
The first study analyzed 2005 to 2016 data from the United Network for Organ Sharing (UNOS) and broke down liver transplantation by four drivers: ALD, non-alcoholic steatohepatitis (NASH), HCV and the combination of HCV and ALD.
The number of individuals receiving liver transplants who had hep C reached its highest point in 2014 at 1,905 people and declined during the subsequent two years. The rate of liver transplants driven by ALD and NASH has seen a steady upswing in recent years. In 2016, liver transplants were driven by ALD in 1,535 cases, by NASH in 1,334 cases and by HCV and ALD in 424 cases.
“Although we found that, overall, alcoholic liver disease became the leading indication for liver transplantation in the U.S. in 2016, NASH was not far behind,” Jennifer Wang, MD, MPH, from the California Pacific Medical Center in San Francisco, said as she presented the study at the liver conference. “Importantly, NASH is now the leading cause of liver transplantation in women, which is not entirely surprising given the higher rates of metabolic syndrome in women and the resultant increased risk of non-alcoholic fatty liver disease.”
Wang added: “In African Americans and those with hepatocellular carcinoma [the most common form of liver cancer], HCV remains the leading cause of transplantation and a major burden.”
The second study also looked at data from the UNOS registry and focused on those without liver cancer who received a liver transplant between January 2012 and October 2017. ALD bumped HCV out of the top slot as the primary driver of such transplantation in 2016. That year, ALD, NASH and HCV were the drivers behind 24 percent, 19 percent and 18 percent of liver transplants, respectively. The following year, the corresponding proportions were 24 percent, 18 percent and 17 percent.
“One of our most worrying findings was that patients with ALD are being listed for liver transplantation at a much younger age and with more severe disease than patients with either HCV infection or NASH,” study investigator George Cholankeril, MD, from Stanford University Medical Center, said at the conference. “These are very ominous trends, and we need to take aggressive action to address these rising rates of liver transplantation in patients with alcoholic liver disease.
To read a press release about the study, click here.