Division of Gastroenterology and Hepatology, Liver Care Line, University of Washington, Seattle, WA.
Center for Liver Investigation Fostering discovEry (C-LIFE), University of Washington, Seattle, WA.
Transplantation. 2019 Jan;103(1):140-148. doi: 10.1097/TP.0000000000002497.
With increasing US adiposity, nonalcoholic steatohepatitis (NASH) is now a leading liver transplant (LT) indication. Given its association with hepatocellular carcinoma (HCC), the burden of NASH is substantial. We analyzed birth cohort effects among NASH LT registrants, with and without HCC.
All new LT registrants in United Network for Organ Sharing (1995-2015) were identified. Birth cohorts were defined as: 1936-1940, 1941-1945, 1946-1950, 1951-1955, 1956-1960, 1961-1965, 1966-1970, 1971-2015. Poisson regression examined trends in LT registration, by disease etiology (NASH, hepatitis C virus [HCV], other liver disease etiologies [OTHER]), and HCC.
We identified 182 368 LT registrants with median age of 52 years (range, 0-86 years). Nine percent (n = 16 160) had NASH, 38% (n= 69 004) HCV, 53% (n = 97 204) OTHER. HCC was present in: 13% (n = 2181), 27% (n = 18 295), and 11% (n = 10 902), of NASH, HCV, and OTHER, respectively. Liver transplant registration for HCC increased significantly from 2002 to 2015 across all etiologies (NASH, 6%-18%; HCV, 19%-51%; OTHER, 9%-16%; P < 0.0001 for all). NASH LT registrations, with and without HCC, increased sharply in patients born from 1945 to 2015. This upward NASH trend is in stark contrast to HCV LT registrations, which showed a general decline. Notably, a sharp rise in LT registrations is occurring among younger NASH patients (35-55 years), mirroring the increasing adiposity across all age groups in the US population.
NASH LT registrants, with and without HCC, have increased over time, and are projected to increase unabated in the future, notably among younger birth cohorts ("Adipose Wave Effect"). HCC LT registration patterns demonstrate that, compared with HCV, NASH patients encompass younger birth cohorts. These data illustrate that the full impact of NASH on demand for LT is yet to be realized.
随着美国肥胖率的上升，非酒精性脂肪性肝炎（NASH）现已成为肝移植（LT）的主要指征。鉴于其与肝细胞癌（HCC）的关联，NASH 的负担很大。我们分析了伴有和不伴有 HCC 的 NASH LT 登记患者的出生队列效应。
在美国器官共享网络（1995-2015 年）中确定所有新的 LT 登记患者。出生队列定义为：1936-1940 年、1941-1945 年、1946-1950 年、1951-1955 年、1956-1960 年、1961-1965 年、1966-1970 年、1971-2015 年。泊松回归分析了按疾病病因（NASH、丙型肝炎病毒 [HCV]、其他肝病病因 [OTHER]）和 HCC 观察到的 LT 登记趋势。
我们确定了 182368 名 LT 登记患者，中位年龄为 52 岁（范围 0-86 岁）。9%（n=16160）患有 NASH、38%（n=69004）HCV、53%（n=97204）OTHER。NASH、HCV 和 OTHER 中 HCC 的检出率分别为：13%（n=2181）、27%（n=18295）和 11%（n=10902）。所有病因 HCC 的 LT 登记自 2002 年至 2015 年均显著增加（NASH：6%-18%；HCV：19%-51%；OTHER：9%-16%；均<0.0001）。伴有和不伴有 HCC 的 NASH LT 登记在 1945 年至 2015 年出生的患者中急剧增加。这种 NASH 上升趋势与 HCV LT 登记形成鲜明对比，后者呈总体下降趋势。值得注意的是，NASH 的 LT 登记在 35-55 岁的年轻患者中急剧上升，反映了美国人口中所有年龄组肥胖率的上升。
伴有和不伴有 HCC 的 NASH LT 登记患者数量随时间推移而增加，预计未来还会继续增加，尤其是在较年轻的出生队列中（“肥胖波效应”）。HCC LT 登记模式表明，与 HCV 相比，NASH 患者涵盖了更年轻的出生队列。这些数据表明，NASH 对 LT 需求的全面影响尚未显现。
