Article: Changes in the Prevalence of Hepatitis C Virus Infection, Non-alcoholic Steatohepatitis, and Alcoholic Liver Disease Among Patients with Cirrhosis or Liver Failure on the Waitlist for Liver Transplantation—D Goldberg et al.
Study Aims and Results
The aim of the study was to understand and compare the most common reasons for the liver transplantation waitlist and what, if any, changes in rankings had occurred since the approval of hepatitis C (HCV) direct-acting antiviral medications. This is an important question since a significant amount of people have been treated and cured of hepatitis C thus reducing the need for inclusion on the liver transplant waitlist.
In the recent past, the three most common reasons for liver transplantation waitlist included (1) chronic hepatitis C (HCV) infection, (2) alcoholic liver disease (ALD), and (3) non-alcoholic liver disease (NASH)-build-up of fat in the liver (in this order).
In the current study, data was collected from the following records: National Health and Nutrition Examination Survey (NHANES), from the 2010 and 2013–2014, HealthCore Integrated Research Database on patients with cirrhosis and chronic liver failure (CLF) from 2006 through 2014 and United Network for Organ Sharing (UNOS) data on patients who received transplants from 2003 through 2015.
The data from the three studies is listed below:
- The NHANES data from 2013-2014: HCV antibody and viral load was 0.5 down from .064 in 2010.
- HealthCore: Liver transplantation waitlist was not addressed in the abstract but the analysis did show that there were decreases in cirrhosis, chronic liver failure and liver cancer from hepatitis C. There was also a decrease in cases of cirrhosis, chronic liver failure and liver cancer attributed to ALD. NASH had 3-fold increase in chronic liver failure, cirrhosis and a small increase in liver cancer.
- UNOS: There was a significant decrease in those with HCV who were waiting for a liver transplant or who were receiving a liver transplant caused by liver cancer or from chronic liver failure. At the same time, there was an increase in patients with NASH or ALD undergoing or waitlisted for a liver transplant. In those patients with NASH or ALD there was no change between 2013 and 2015 in those undergoing a liver transplant or who were liver transplant waitlisted.
Take Home Message
In an analysis of 3 different databases (NHANES, HealthCore, and UNOS), it was found that the liver transplant waitlist from the disease consequences from HCV were decreasing but consequences from NASH and ALD were increasing.
The number one indication for liver transplants is still complications from HCV, but NASH and ALD are quickly catching up. The good news is that the new HCV direct-acting antiviral medications are curing many people before they need a liver transplant. The need for monitoring after being cured of hepatitis C, however, is still needed because some people, especially those with cirrhosis, can still progress on to serious disease progression. NASH due to a poor diet and lack of exercise is affecting millions of Americans. It is a deadly disease that can lead to cirrhosis, liver failure, liver cancer, the need for liver transplantation and unfortunately for some people death. Alcoholic liver disease is still a very large health problem among Americans that can lead to cirrhosis, liver cancer, the need for a liver transplant and death.
Alan Franciscus is the Executive Director of the Hepatitis C Support Project and the Editor-in-Chief of the HCV Advocate Website