From the Section of Digestive Diseases and Nutrition.
Department of Medicine.
South Med J. 2024 Jun;117(6):302-310. doi: 10.14423/SMJ.0000000000001699.
Our aim was to provide an up-to-date, large-scale overview of the trends and clinicodemographics for NASH LTs performed in the United States compared with all other LT indications between 2000 and 2022. We also examined the demographic factors that will predict future demand for NASH LT.
Our analysis of NASH LT from the Organ Procurement & Transplantation Network database spanning 2000-2022 consisted primarily of descriptive statistics and hypothesis testing with corrections for multiple testing when necessary. Trend lines and linear correlations were also explored.
NASH LTs have experienced a remarkable surge, escalating from 0.12% of all LTs in 2000 to a substantial 14.7% in 2022, marking a 100-fold increase. Examining demographic trends, a significant proportion of NASH LTs recipients fall within the 50- to 64-year-old age group. Moreover, 52% of these recipients concurrently exhibit type 2 diabetes mellitus, a notably higher percentage than the 19% observed in all LT recipients. Type 2 diabetes mellitus emerges as a prominent risk factor for NASH progressing to end-stage liver disease. The phenomenon of repeat transplantation is noteworthy; although 6% of all LTs necessitate repeat procedures, this figure dramatically drops to 0.6% for NASH LTs. Ethnic disparities are apparent, with African Americans representing a mere 2% of NASH LT recipients, significantly lower than their representation in the overall population. Regionally, the East Coast has a higher proportion of NASH LT recipients compared with waitlist additions. This trend holds true across demographics.
Our findings underscore the need for increased resources, particularly for minority, uninsured, or noncitizen individuals requiring LT for NASH. This analysis provides valuable insights into the dynamic landscape of LTs in the context of NASH, shaping the trajectory of medical interventions in the 21st century.
本研究旨在提供 2000 年至 2022 年间美国非酒精性脂肪性肝炎（NASH）肝移植（LT）与其他所有 LT 适应证相比的趋势和临床病理特征的最新、大规模概述。我们还研究了预测未来 NASH LT 需求的人口统计学因素。
我们主要使用描述性统计和假设检验分析了 2000 年至 2022 年期间美国器官获取和移植网络（OPTN）数据库中 NASH LT 的数据，必要时对多次检验进行了校正。还探索了趋势线和线性相关性。
NASH LT 经历了显著增长，从 2000 年所有 LT 的 0.12%增加到 2022 年的 14.7%，增长了 100 倍。从人口统计学趋势来看，相当比例的 NASH LT 受者年龄在 50 至 64 岁之间。此外，52%的受者同时患有 2 型糖尿病，这一比例明显高于所有 LT 受者的 19%。2 型糖尿病是 NASH 进展为终末期肝病的一个重要危险因素。重复移植现象值得关注；虽然所有 LT 中有 6%需要重复手术，但 NASH LT 这一比例急剧下降至 0.6%。存在明显的种族差异，非裔美国人仅占 NASH LT 受者的 2%，明显低于他们在总人口中的比例。从区域上看，东海岸 NASH LT 受者的比例高于候补名单中的增加人数。这种趋势在各个人群中都存在。
我们的研究结果强调了需要增加资源，特别是为需要 LT 治疗 NASH 的少数民族、未保险或非公民个人提供资源。本分析为 NASH 背景下 LT 的动态情况提供了有价值的见解，为 21 世纪的医疗干预措施指明了方向。
