Nonalcoholic fatty liver disease is an increasing indication for liver transplantation in the Nordic countries

Holmer, Magnus; Melum, Espen; Isoniemi, Helena; Ericzon, Bo‐Göran; Castedal, Maria; Nordin, Arno; Schultz, Nicolai Aagaard; Rasmussen, Allan; Line, Pål–Dag; Stål, Per; Bennet, William; Hagström, Hannes

doi:10.1111/liv.13751

Cited by 51 publications

(46 citation statements)

References 37 publications

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“…Within ANZ, NASH currently only represents approximately 12% of all transplants. Similarly, a recent analysis of the Nordic Liver Transplant Registry demonstrated that NAFLD as an indication for LT increased significantly between 1994 to 2015 but only represented 6% of adult LTs between 2011 and 2015 . It is notable that the velocity of obesity rates increased significantly in Australia after 1995 from an average increase of 3.1% per decade to a 6.0% increase per decade .…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, a recent analysis of the Nordic Liver Transplant Registry demonstrated that NAFLD as an indication for LT increased significantly between 1994 to 2015 but only represented 6% of adult LTs between 2011 and 2015. (18) It is notable that the velocity of obesity rates increased significantly in Australia after 1995 from an average increase of 3.1% per decade to a 6.0% increase per decade. (1) Subsequently, there was a significant increase in NASH-related transplantation 1 decade later (Table 2), demonstrating the longterm sequelae of obesity-related liver disease.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…Non-alcoholic fatty liver disease (NAFLD), affecting about 25% of the global population, 5,6 has emerged as one of the leading causes of cirrhosis and HCC. [7][8][9] HCC is associated with poor survival, especially in later stages of the disease. 10,11 Screening with hepatic ultrasound biannually to detect early forms of HCC when curative treatment is still an option is therefore recommended.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and outcome of hepatocellular carcinoma in patients with NAFLD without cirrhosis

Bengtsson

Stål

Wåhlin

et al. 2019

Liver International

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Background and Aims: Non-alcoholic fatty liver disease (NAFLD) is a growing cause of hepatocellular carcinoma (HCC). In NAFLD, HCC occurs more commonly in the absence of cirrhosis compared with other liver diseases; yet, patients with non-cirrhotic NAFLD-HCC are poorly characterized. Here, we characterized a large cohort of HCC cases and assessed the outcomes of patients with non-cirrhotic NAFLD-HCC. Methods:We identified all cases of HCC treated at the Karolinska University Hospital, Stockholm, Sweden from 2004 to 2017. Patient charts were manually reviewed for variable extraction. Cases were followed passively for all-cause and HCC-related mortality until the end of April 2018. Cox regression was performed to estimate mortality rates and identify mortality risk factors in patients with non-cirrhotic NAFLD-HCC.Results: Totally, 1562 cases with HCC were identified. Of these, 225 (14.4%) had NAFLD-HCC, of which 83 (37%) did not have cirrhosis. Compared with patients with cirrhotic NAFLD-HCC, patients with non-cirrhotic NAFLD-HCC were older (74 vs 70 years, P < 0.001), had a lower prevalence of type 2 diabetes (T2DM) (66% vs 80%, P = 0.02), larger tumours, less frequently underwent liver transplantation (0% vs 11%, P = 0.002), but more frequently underwent resection (35% vs 8%, P < 0.001).Mortality was similar (aHR for non-cirrhotic NAFLD-HCC vs cirrhotic NAFLD-HCC 0.93, 95% CI 0.58-1.51, P = 0.78). Parameters independently associated with increased mortality included the Barcelona Clinic Liver Cancer stage, number of tumours, lower albumin and presence of T2DM. Conclusions:Patients with non-cirrhotic NAFLD-HCC differ from those with cirrhosis in age, tumour size and allocated treatments. Despite these differences, survival is similar. K E Y W O R D S cirrhosis, curative treatment, epidemiology, HCC, NAFLD, prognosis, survival | 1099 BENGTSSON ET al.

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“…Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease globally [ 1 ] and is projected to become the main indication for liver transplantation in the US in the coming decade [ 2 ] and also an increasing indication for liver transplantation in the Nordic countries [ 3 ]. Histologically, NAFLD is divided into two major subgroups, nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH).…”

Section: Introductionmentioning

confidence: 99%

Steatohepatitis Is Not Associated with an Increased Risk for Fibrosis Progression in Nonalcoholic Fatty Liver Disease

Hagström

Elfwén

Hultcrantz

et al. 2018

Gastroenterology Research and Practice

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Introduction Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease globally. The majority of NAFLD patients have fatty liver without inflammation (nonalcoholic fatty liver, NAFL), whereas a minority develop steatohepatitis (nonalcoholic steatohepatitis, NASH). Only NASH and not NAFL has been considered to increase the risk for fibrosis progression. The present study investigates risk factors for fibrosis progression in patients with NAFLD, and if fibrosis progression associates with subsequent mortality. Material and Methods All patients with at least two liver biopsies more than a year apart at our hospital between 1971 and 2016 were identified. Data on plausible risk factors for fibrosis progression were collected. Biopsies were scored for the presence of NASH and fibrosis stage. Regression models were used to investigate the association between baseline NASH and fibrosis progression and fibrosis progression with future mortality. Results 60 patients had undergone serial biopsies (median interval between biopsies 8.4 years, range 1–33 years), with 26 patients (43%) having fibrosis progression. We found no significant risk factors for progression of fibrosis except time between biopsies. Among patients with fibrosis progression, 54% had NAFL and 46% had NASH at baseline. There was a trend for an association between fibrosis progression per se and increased mortality (hazard ratio 2.83, 95% CI 1.0–8.1, p = 0.05). Conclusions In this study on NAFLD, baseline steatohepatitis was not associated with an increased risk for fibrosis progression. NAFLD patients without steatohepatitis may develop progressive fibrosis, and those with progressive fibrosis appear to have a higher mortality risk irrespective of baseline NASH status.

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Nonalcoholic fatty liver disease is an increasing indication for liver transplantation in the Nordic countries

Abstract: NAFLD is an increasing indication for liver transplantation in the Nordic countries. Despite more advanced liver disease, NAFLD patients have a comparable survival to other patients listed for liver transplantation.

Cited by 51 publications

References 37 publications

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

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

Characteristics and outcome of hepatocellular carcinoma in patients with NAFLD without cirrhosis

Steatohepatitis Is Not Associated with an Increased Risk for Fibrosis Progression in Nonalcoholic Fatty Liver Disease

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