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Younossi ZM, Stepanova M, Al Shabeeb R, Eberly KE, Shah D, Nguyen V, Ong J, Henry L, Alqahtani SA. The changing epidemiology of adult liver transplantation in the United States in 2013-2022: The dominance of metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease. Hepatol Commun 2024; 8:e0352. [PMID: 38126928 PMCID: PMC10749707 DOI: 10.1097/hc9.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/04/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND 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. METHODS The Scientific Registry of Transplant Recipients (SRTR 2013-2022) was used to select adult (18 years or above) candidates who underwent liver transplant. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Zobair M. Younossi
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
- The Global NASH Council, Washington, District of Columbia, USA
| | - Maria Stepanova
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
- The Global NASH Council, Washington, District of Columbia, USA
| | - Reem Al Shabeeb
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
| | - Katherine E. Eberly
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
| | - Dipam Shah
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
| | - Veronica Nguyen
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
| | - Janus Ong
- The Global NASH Council, Washington, District of Columbia, USA
- Department of Internal Medicine, College of Medicine, University of the Philippines, Manila, Philippines
| | - Linda Henry
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
- The Global NASH Council, Washington, District of Columbia, USA
- Center for Outcomes Research in Liver Diseases, Washington, District of Columbia, USA
| | - Saleh A. Alqahtani
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
- Center for Outcomes Research in Liver Diseases, Washington, District of Columbia, USA
- Epidemiology & Scientific Computing Department, Liver Transplant Center and Biostatistics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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Ray S, Shwaartz C, Sayed BA, Sapisochin G, Ghanekar A, McGilvray I, Cattral M, Lilly L, Selzner N, Tsien C, Bhat M, Jaeckel E, Selzner M, Reichman TW. Should advanced donor age be a deterrent in the utilization of grafts from donation after cardiac death in deceased donor liver transplantation? The Toronto experience. Can J Surg 2023; 66:E561-E571. [PMID: 38016726 DOI: 10.1503/cjs.001123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Advanced donor age paired with donation after cardiac death (DCD) increases the risk of transplantation, precluding widespread use of grafts from such donors worldwide. Our aim was to analyze outcomes of liver transplantation using grafts from older DCD donors and donation after brain death (DBD) donors. METHODS Patients who underwent liver transplantation using grafts from deceased donors between January 2016 and December 2021 were included in the study. Short-and long-term outcomes were analyzed for 4 groups of patients: those who received DCD and DBD grafts from younger (< 50 yr) and older (≥ 50 yr) donors. RESULTS Of the 807 patients included in the analysis, 44.7% (n = 361) of grafts were received from older donors, with grafts for older DCD donors comprising 4.7% of the total cohort (n = 38). Patients who received grafts from older donors had a lower incidence of biliary strictures than those who received grafts from younger donors (7.9% v. 20.0% for DCD donation, p = 0.14, and 4.9% v. 6.8% for DBD donation, p = 0.34), with a significantly lower incidence of ischemic-type biliary strictures in patients who received grafts from older versus younger DCD donors (2.6% v. 18.0%, p = 0.04). There was no difference in 1- and 3-year graft survival rates among patients who received grafts from older and younger DCD donors (92.1% v. 90.8% and 80.2% v. 80.9%, respectively) and those who received grafts from older and younger DBD donors (90.1% v. 93.2% and 85.3% v. 84.4%, respectively) (p = 0.85). Pretransplantation admission to the intensive care unit (hazard ratio [HR] 9.041, p < 0.001) and nonalcoholic steatohepatitis (HR 2.197, p = 0.02) were found to significantly affect survival of grafts from older donors. CONCLUSION Donor age alone should not be the criterion to determine the acceptability of grafts in liver transplantation. With careful selection criteria, older DCD donors could make a valuable contribution to expanding the liver donor pool, with grafts that produce comparable results to those obtained with standard-criteria grafts.
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Affiliation(s)
- Samrat Ray
- From the Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ont. (Ray, Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman); and the Department of Surgery, University of Toronto, Toronto, Ont. (Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman)
| | - Chaya Shwaartz
- From the Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ont. (Ray, Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman); and the Department of Surgery, University of Toronto, Toronto, Ont. (Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman)
| | - Blayne Amir Sayed
- From the Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ont. (Ray, Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman); and the Department of Surgery, University of Toronto, Toronto, Ont. (Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman)
| | - Gonzalo Sapisochin
- From the Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ont. (Ray, Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman); and the Department of Surgery, University of Toronto, Toronto, Ont. (Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman)
| | - Anand Ghanekar
- From the Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ont. (Ray, Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman); and the Department of Surgery, University of Toronto, Toronto, Ont. (Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman)
| | - Ian McGilvray
- From the Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ont. (Ray, Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman); and the Department of Surgery, University of Toronto, Toronto, Ont. (Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman)
| | - Mark Cattral
- From the Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ont. (Ray, Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman); and the Department of Surgery, University of Toronto, Toronto, Ont. (Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman)
| | - Leslie Lilly
- From the Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ont. (Ray, Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman); and the Department of Surgery, University of Toronto, Toronto, Ont. (Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman)
| | - Nazia Selzner
- From the Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ont. (Ray, Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman); and the Department of Surgery, University of Toronto, Toronto, Ont. (Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman)
| | - Cynthia Tsien
- From the Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ont. (Ray, Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman); and the Department of Surgery, University of Toronto, Toronto, Ont. (Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman)
| | - Mamatha Bhat
- From the Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ont. (Ray, Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman); and the Department of Surgery, University of Toronto, Toronto, Ont. (Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman)
| | - Elmar Jaeckel
- From the Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ont. (Ray, Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman); and the Department of Surgery, University of Toronto, Toronto, Ont. (Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman)
| | - Markus Selzner
- From the Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ont. (Ray, Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman); and the Department of Surgery, University of Toronto, Toronto, Ont. (Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman)
| | - Trevor W Reichman
- From the Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ont. (Ray, Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman); and the Department of Surgery, University of Toronto, Toronto, Ont. (Schwaartz, Sayed, Sapisochin, Ghanekar, McGilvray, Cattral, Lilly, N. Selzner, Tsien, Bhat, Jaeckel, M. Selzner, Reichman)
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