Inova Fairfax Hospital, Center for Liver Diseases, Department of Medicine, Falls Church, VA, United States; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States. Electronic address: email@example.com.
Center for Outcomes Research in Liver Disease, Washington, DC, United States.
College of Medicine, University of Philippines, Manila, Philippines.
New York University School of Medicine, New York, NY, United States.
University of Torino, Department of Medical Sciences, Division of Gastroenterology, Torino, Italy.
Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Saga University Hospital, Saga, Japan.
The Chinese University of Hong Kong, Hong Kong, China.
University de Geneve, Geneve, Switzerland.
Marmara University, Marmara, Turkey.
Virgin del Rocio University Hospital, Sevilla, Spain.
Sorr Liver Centre, The Westmead Institute of Medical Research, University of Sydney, and Westmead Hospital, Sydney, Australia.
Stanford University School of Medicine, Stanford, CA, United States.
Alameda Health System, Oakland, CA, United States.
While hepatitis B and C have been the main drivers of hepatocellular carcinoma (HCC), non-alcoholic steatohepatitis (NASH) has recently become an important cause of HCC. The aim of this study was to assess the causes of HCC among liver transplant (LT) candidates in the U.S.
The Scientific Registry of Transplant Recipients (2002-2016) was used to estimate the trends in prevalence of HCC in LT candidates with the most common types of chronic liver disease: alcoholic liver disease (ALD), chronic hepatitis B (CHB), chronic hepatitis C, and NASH.
158,347 adult LT candidates were included. Of these, 26,121 (16.5%) had HCC; this proportion increased from 6.4% (2002) to 23.0% (2016) (trend p<0.0001). Over the study period, CHC remained the most common etiology for HCC (65%). The proportions of HCC accounted for by CHC and ALD remained stable (both trend p>0.10), the proportion of CHB decreased 3.1-fold (p<0.0001), while the proportion of NASH in HCC increased 7.7-fold (from 2.1% to 16.2%, p<0.0001). Furthermore, since 2002, the prevalence of HCC in LT candidates with NASH increased 11.8-fold, while this rate increased 6.0-fold in CHB, 3.4-fold in ALD and 2.3-fold in CHC (all p<0.0001); the increasing trend in NASH was steeper than that for any other etiology (p<0.0001 in a trend regression model). The proportion of LT candidates with HCC who were ultimately transplanted or died while waiting did not differ between etiologies (p>0.05).
Non-alcoholic steatohepatitis is the most rapidly growing cause of HCC among U.S. patients listed for liver transplantation.