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

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

doi:10.1002/lt.25361

Cited by 43 publications

(40 citation statements)

References 32 publications

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“…We would then be able to analyze the impact of the degree of liver fibrosis and disease severity on outcomes. In 2017, patients with NAFLD accounted for an alarming 10% of patients undergoing liver transplantation in the United States [30]. Our study reinforces the need for further investigation of NAFLD related all-cause mortality in terms of gender differences.…”

Section: Discussionsupporting

confidence: 68%

Increased Incidence and Prevalence of Cardiovascular Events and Mortality in Female Patients with NAFLD: A Meta-Analysis and Meta-Regression

Yaser¹,

Neethi²,

Herman³

et al. 2020

Int J Clin Cardiol

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Background: Non-alcoholic fatty liver disease (NAFLD) and cardiovascular diseases (CVD) share similar risk factors. Recent studies have focused on obesity and insulin-resistance, but the link between NAFLD and CVD persists regardless of traditional risk factors. Despite the increased incidence and prevalence of NAFLD worldwide , there has been no thorough investigation of gender disparities nor a closer look taken into investigating the role gender may play in increased cardiovascular (CV) mortality incidence and prevalence in patients with NAFLD. Objective: We assessed incidence and prevalence of CV events and mortality based on gender in patients with NA-FLD, at any stage of fibrosis. A meta-regression was conducted to further analyze the impact of age on both genders. Methods: An aggregate analysis was performed on ten studies with NAFLD patients. A random-effects model was used to pool the overall incidence and prevalence rates of CV events and mortality as well as all-cause mortality to examine any gender disparity. We also performed a meta-regression analysis to evaluate the effect of age on mortality for men versus women with NAFLD and CV events and mortality. Summary odds ratios (OR) and 95% confidence intervals (CI) were estimated using a random-effects model. Results: In 259,598 patients with NAFLD, of which 44% were females and 56% were males, all-cause mortality was 1.5 × higher in women compared to men (OR 1.65, 95% CI 1.12-2.43, p < 0.012). CV events and mortality were also 2 × higher in women compared to men (OR 2.12 95% CI 1.65-2.73, p < 0.001). On meta-regression, females had higher mortality with advancing age starting at age 42 (coefficient = 0.0518, p = 0.00001). Conclusion: For patients with NAFLD, women had a markedly higher incidence and prevalence of CV events, CV mortality and all-cause mortality when compared to men. Meta-regression showed increased mortality among women with advancing age. As the incidence and prevalence of NAFLD and concomitant CV events increases worldwide, we urge the medical community to increase surveillance and perform rigorous cardiovascular risk assessments for women, especially beginning at age 42. Additionally, we recommend heterogenous surveys of gender disparities, increased focus on gender as a decisive factor for downstream CV events, the relationship between NAFLD severity and gender-based mortality differences, and larger studies representing equivalent male and female populations.

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Section: Discussionsupporting

confidence: 68%

Increased Incidence and Prevalence of Cardiovascular Events and Mortality in Female Patients with NAFLD: A Meta-Analysis and Meta-Regression

Yaser¹,

Neethi²,

Herman³

et al. 2020

Int J Clin Cardiol

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“…Based on expert input and analysis of diagnostic categories for transplant recipients, it was estimated that approximately 15% of current liver transplants are attributable to NAFLD/NASH. Analysis of liver transplant data from Australia and New Zealand has shown that NASH as an indicator grew from 2.0% in 2003 to 10.9% in 2017, making it the third leading indicator for liver transplants . Given the uncertainties around transplant demand and availability, it was assumed that the annual number of transplants would remain constant through 2030.…”

Section: Methodsmentioning

confidence: 99%

Nonalcoholic fatty liver disease burden: Australia, 2019–2030

Adams

Roberts

Strasser

et al. 2020

J of Gastro and Hepatol

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Background and Aim: Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) account for a large and growing proportion of liver disease burden globally. The burden of NAFLD/NASH manifests in increasing levels of advanced liver disease and primary liver cancer in Australia. A Markov model was used to forecast NAFLD burden in Australia through 2030. Methods: A model was used to estimate fibrosis progression, primary liver cancer, and liver deaths among the Australian NAFLD population, with changes in incident NAFLD cases based on long-term trends for changes in the prevalence of obesity. Published estimates and surveillance data were applied to build and validate the model projections, including surveillance data for the incidence of liver cancer. Results: Prevalent NAFLD cases were projected to increase 25% from the current burden (5 551 000 [4 748 000-6 306 000] cases in 2019) to 7 024 000 [5 838 000-7 886 000] cases in 2030. The projected increase in the number of NASH cases (40%) was greater than that of NAFLD cases. Incident cases of advanced liver disease are projected to increase up to 85% by 2030, and incident NAFLD liver deaths are estimated to increase 85% from 1900 (1100-3300) deaths in 2019 to 3500 (2100-6100) deaths in 2030. Conclusions: Restraining growth of the obese and diabetic populations, along with potential therapeutic options, will be essential for mitigating disease burden.

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“…Data from the European Transplant Registry also show an increase in transplantation for NAFLD-related HCC from 0.2% in 2007 to 1.2% in 2017 [40] . In Australia and New Zealand, NAFLD is the third leading cause of HCC in those who underwent transplantation, and an Australian cohort of 272 HCC patients found NAFLD to be the underlying aetiology with 14% of cases [41,42] . A summary of these cohorts is outlined in Table 1.…”

Section: Prevalence Of Nafld-related Hccmentioning

confidence: 99%

Epidemiology of non-alcoholic fatty liver disease-related hepatocellular carcinoma: a western perspective

Farrell¹,

Howell²

2020

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Non-alcoholic fatty liver disease (NAFLD) is now the most common cause of liver disease worldwide, and represents an increasingly important cause of hepatocellular carcinoma (HCC). As the prevalence of NAFLD has increased, the burden of NAFLD-related HCC has been rising in parallel. This is particularly evident in Western countries, where NAFLD is estimated to account for 10%-59% of all HCC. NAFLD-related HCC can occur in the presence or absence of cirrhosis, and, while those with cirrhosis remain at the greatest risk, factors such as steatohepatitis, age, genetic polymorphisms, type 2 diabetes mellitus and obesity also appear have an impact on the risk of developing HCC in NAFLD. In this review, we present the epidemiology of NAFLD-related HCC from a Western perspective, highlighting gaps in current knowledge and future directions for research in this field.

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

Cited by 43 publications

References 32 publications

Increased Incidence and Prevalence of Cardiovascular Events and Mortality in Female Patients with NAFLD: A Meta-Analysis and Meta-Regression

Increased Incidence and Prevalence of Cardiovascular Events and Mortality in Female Patients with NAFLD: A Meta-Analysis and Meta-Regression

Nonalcoholic fatty liver disease burden: Australia, 2019–2030

Epidemiology of non-alcoholic fatty liver disease-related hepatocellular carcinoma: a western perspective

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