Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA.
The Global NASH Council, Washington, District of Columbia, USA.
Hepatol Commun. 2023 Dec 22;8(1). doi: 10.1097/HC9.0000000000000352. eCollection 2024 Jan 1.
The high prevalence of obesity in the United States drives the burden of NASH, recently renamed as metabolic dysfunction-associated steatohepatitis (MASH). We assessed the most recent trends in liver transplantation in the United States.
The Scientific Registry of Transplant Recipients (SRTR 2013-2022) was used to select adult (18 years or above) candidates who underwent liver transplant.
There were 116,292 candidates who underwent liver transplant with known etiology of chronic liver disease. In candidates without HCC, the most common etiology was alcohol-associated liver disease (ALD), increasing from 23% (2013) to 48% (2022), followed by NASH/MASH, which increased from 19% to 27%; the rates of viral hepatitis decreased (chronic hepatitis C: 28%-4%; chronic hepatitis B: 1.8%-1.1%) (all trend p<0.01). The proportion of HCC decreased from 25% (2013-2016) to 17% (2021-2022). Among HCC cohort, the proportion of chronic hepatitis C decreased from 60% (2013) to 27% (2022), NASH/MASH increased from 10% to 31%, alcohol-associated liver disease increased from 9% to 24% (trend p<0.0001), and chronic hepatitis B remained stable between 5% and 7% (trend p=0.62). The rapid increase in the proportion of NASH/MASH in HCC continued during the most recent study years [20% (2018), 28% (2020), 31% (2022)]; the trend remained significant after adjustment for age, sex, ethnicity, obesity, and type 2 diabetes.
Liver transplant etiologies in the United States have changed over the last decade. Alcohol-associated liver disease and NASH/MASH remain the 2 most common indications for transplantation among those without HCC, and NASH/MASH is the most common in patients with HCC.
美国肥胖症的高患病率导致非酒精性脂肪性肝炎（NASH）的负担加重，最近更名为代谢相关脂肪性肝炎（MASH）。我们评估了美国肝移植的最新趋势。
使用移植受者科学登记处（SRTR 2013-2022）选择接受肝移植的成年（18 岁或以上）候选者。
在已知慢性肝病病因的 116292 名候选者中，无 HCC 的情况下，最常见的病因是酒精性肝病（ALD），从 23%（2013 年）增加到 48%（2022 年），其次是 NASH/MASH，从 19%增加到 27%；病毒性肝炎的发病率下降（慢性丙型肝炎：28%-4%；慢性乙型肝炎：1.8%-1.1%）（所有趋势 p<0.01）。HCC 的比例从 25%（2013-2016 年）下降到 17%（2021-2022 年）。在 HCC 队列中，慢性丙型肝炎的比例从 60%（2013 年）下降到 27%（2022 年），NASH/MASH 从 10%增加到 31%，酒精性肝病从 9%增加到 24%（趋势 p<0.0001），慢性乙型肝炎在 5%-7%之间保持稳定（趋势 p=0.62）。NASH/MASH 在 HCC 中的比例在最近的研究年份（20%[2018 年]、28%[2020 年]、31%[2022 年]）中迅速增加，调整年龄、性别、种族、肥胖和 2 型糖尿病后，这一趋势仍然显著。
美国肝移植的病因在过去十年中发生了变化。酒精性肝病和 NASH/MASH 仍然是非 HCC 患者肝移植的两个最常见指征，而 NASH/MASH 是 HCC 患者最常见的病因。
