Rising Rate of Liver Transplantation in the Baby Boomer Generation with Non-alcoholic Steatohepatitis in the United States

Abstract

Background and Aims: Nonalcoholic steatohepatitis (NASH) is the most rapidly growing indication for liver transplantation (LT) in the United States and is on a trajectory to become the leading indication for LT in the next decade. We aimed to study the trends in NASH-related LT among persons born between 1945 and 1965, the baby boomer (BB) generation.Methods: We performed a retrospective cohort analysis using population-based data from the United Network for Organ Sharing/Organ Procurement and Transplantation Network registry from 2004–2015 to evaluate the birth cohort-specific trends in liver transplant waitlist registrations and liver transplant surgeries in patients with NASH. We stratified our study population into three birth cohorts: 1) birth before 1945, 2) birth between 1945 and 1965, and 3) birth after 1965.Results: The overall rates of NASH-related waitlist registrations and liver transplant surgeries steadily increased from 2004 to 2015 and were reflective of a sharp rise noted in the NASH BB sub-group. From 2004 to 2015, the proportion of BB patients with NASH added to LT waitlist demonstrated an incremental growth, 60.6% in 2004 versus 83.2% in 2015 (p < 0.01). Among the liver transplant recipients with NASH, the proportion represented by the BB cohort increased from 56.3% in 2004 to 80.0% in 2015 (p < 0.01).Conclusions: We report rising rates of waitlist registration and LT for the indication of NASH. More importantly, the BB sub-cohort was mainly responsible for these alarming trends.

Multidisciplinary Approach for Liver Transplantation in Patients with Nonalcoholic Steatohepatitis: It Takes a Village

“…25 Even in the baby boomer generation (persons born between 1945 and 1965), which was considered the hepatitis C generation, the proportion of patients with NASH added to LT waitlist has demonstrated incremental growth, up to 83.2% in 2015, compared with 60.6% in 2004 (p < 0.01). 26 The proportion of baby boomer LT recipients with NASH also increased incrementally, coming in second after recipients with HCV. 27 While the number of waitlist registrants with NASH is rapidly increasing, earlier studies demonstrated that patients with NASH are less likely to receive an LT when compared with patients with HCV; the NASH patients were ultimately more likely to be delisted or die before receiving an LT. 28 However, in an analysis of the UNOS data from 2002 to 2016, Thuluvath et al demonstrated that patients with NASH are not disadvantaged by higher waitlist removal or lower transplant rates when compared with their counterparts with other liver disease etiologies.…”

Impact of Morbid Obesity on Liver Transplant Candidacy and Outcomes: National and Regional Trends

“…1 Nonalcoholic steatohepatitis (NASH), the most severe form of nonalcoholic fatty liver disease, is currently the most prevalent chronic liver disease in the United States, affecting >5% of the US adult population. [2][3][4][5][6] Besides lifestyle modifications early in the phase of fatty liver disease, there are presently no treatments that can reverse NASH. Up to 25% of these patients will progress to cirrhosis, particularly female and ethnic minority patients.…”