Changes in the Prevalence of Hepatitis C Virus Infection, Nonalcoholic Steatohepatitis, and Alcoholic Liver Disease Among Patients With Cirrhosis or Liver Failure on the Waitlist for Liver Transplantation

Abstract

Background & Aims Concurrent to development of more effective drugs for treatment of hepatitis C virus (HCV), infection, there has been an increase in the incidence of non-alcoholic fatty liver disease (NAFLD). Data indicate that liver transplantation prolongs survival times of patient with acute hepatitis associated with alcoholic liver disease (ALD). We compared data on disease prevalence in the population with data from liver transplantation waitlists to evaluate changes in the burden of liver disease in the United States. Methods We collected data on the prevalence of HCV from the National Health and Nutrition Examination Survey (NHANES), from the 2010 and 2013–2014 cycles. We also collected data from the HealthCore Integrated Research Database on patients with cirrhosis and chronic liver failure (CLF) from 2006 through 2014, and data on patients who received transplant from the United Network for Organ Sharing (UNOS), from 2003 through 2015. We determined percentages of new waitlist members and transplant recipients with HCV infection, stratified by indication for transplant, modeling each calendar year as a continuous variable using the Spearman rank correlation, non-parametric test of trends, and linear regression models. Results In an analysis of data from the NHANES (2013–2014), we found that the proportion of patients with a positive HCV antibody who had a positive HCV RNA was 0.5 (95% CI, 0.42–0.55); this value was significantly lower than in 2010 (0.64; 95% CI, 0.59–0.73) (P=.03). Data from the HealthCore databased revealed significant changes (P<.05 for all), over time, in percentages of patients with compensated cirrhosis (decreases in percentages of patients with cirrhosis from HCV or ALD, but increase in percentages of patients with cirrhosis from non-alcoholic steatohepatitis [NASH]), CLF (decreases in percentages of patients with CLF from HCV or ALD, with an almost 3-fold increase in percentage of patients with CLF from NASH), and hepatocellular carcinoma (HCC) (decreases in percentages of patients with HCC from HCV or ALD and a small increase in HCC among persons with NASH). Data from the UNOS revealed that among patients new to the liver transplant waitlist, or undergoing liver transplantation, for CLF, there was a significant decrease in the percentage with HCV infection and increases in percentages of patients with NAFLD or ALD. Among patients new to the liver transplant waitlist, or undergoing liver transplantation, for HCC, proportions of those with HCV infection, NAFLD, or ALD did not change between 2003 and 2015 Conclusions In an analysis of 3 different databases (NHANES, HealthCore, and UNOS), we found the proportion of patients on the liver transplant waitlist or undergoing liver transplantation for chronic HCV infection to be decreasing, and fewer patients to have cirrhosis or CLF. However, the percentages of patients on the waitlist or receiving liver transplants for NASH or ALD are increasing, despite different relative burdens of disease among the entire population of patie...

Alcoholic Liver Disease Replaces Hepatitis C Virus Infection as the Leading Indication for Liver Transplantation in the United States

“…Similarly, NASH continues to grow as an indication for liver transplantation. 2 Measures are needed to aggressively address these ominous trends in the rising rates of ALD and NASH-related liver transplantation.…”

“…1 Furthermore, data through 2015 demonstrated a decline in the number of HCV-related LT waitlist registrations and LT surgeries following the introduction of DAA-based regimens. 2,3 Despite the downtrend, primary diagnosis of HCV remained the most common cause for liver transplantation in the United States until the end of 2015. 3 In this updated report, we evaluated the current impact of DAA era on the rate of HCV-related liver transplantation in the United States.…”

Same policy, different impact: Center‐level effects of share 35 liver allocation

“…Many of the centers that experienced a large increase in volume of aMELD ≥35 transplants following Share 35 implementation, specifically those outside of region 5, exhibited a concomitant increase in new wait-listings of patients with listing-MELD ≥35 at the time of initial listing. The largest absolute and relative increases in new listing-MELD ≥35 wait-listings and aMELD ≥35 transplants post-Share 35 were for younger patients with alcohol-induced liver disease (12). These increases coincided with a report by Mathurin et al on the success of liver transplantation in patients with acute alcoholic hepatitis (13).…”

Insights into the Epidemiology, Pathogenesis, and Therapeutics of Nonalcoholic Fatty Liver Diseases

“…[229][230][231] Leaving the possibility of transplant rejection aside, the transplanted liver cannot be protected from the risk of NAFLD, and its high cost and the low availability of suitable liver resources limit the application of LT. [229][230][231] Leaving the possibility of transplant rejection aside, the transplanted liver cannot be protected from the risk of NAFLD, and its high cost and the low availability of suitable liver resources limit the application of LT.…”