NASH transplant waitlist expected to increase following obesity trends
In concordance with increasing rates of obesity in the U.S., researchers estimate there will be about a 55% increase in nonalcoholic steatohepatitis as indication for liver transplant over the next 15 years, according to results from a recent study.
“We demonstrated an increase in NASH-related liver transplant waitlist additions is expected to occur 9 years after population-level increases in obesity,” Neehar D. Parikh, MD, from the University of Michigan, and colleagues wrote. “Given limited donor supply in the U.S., reductions in obesity on a population-level are particularly important to reduce the burden of NASH and NASH-related complications.”
To determine the relationship between obesity and NASH-related liver transplant, the researchers analyzed data from the Organ Procurement and Transplantation Network from 2000 to 2014 for liver transplant indications and data from 40,694 National Health and Nutrition Examination Survey records from 1999 to 2014 for obesity prevalence.
There was a steady increase in obesity in the U.S. between 2000 and 2014, with a total increase of 44.9% during that period. Similarly, NASH-related additions to the liver transplant waitlist increased by 410% between 2000 (n = 391) and 2014 (n = 1,605). From 2000 to 2003, clinicians used the code “obese cryptogenic” for 98% of patients with NASH, whereas between 2012 and 2014, clinicians used NASH for 86% of patients.
Results showed that obesity rates are likely to continue increasing, with an estimate that over 92 million U.S. adults aged 18 years to 74 years in 2025 will have obesity, and rates for NAFLD are likely to increase from 1,354 to 2,104 between 2016 and 2030, a growth rate of 55.4%.
Depending on the degree of time lag from increased obesity rates, the long-term projections for increased NASH-related waitlist additions range from 1,354 to 1,771 in 2016; from 1,574 to 1,880 in 2020; and from 1,694 to 2,413 in 2030.
On univariate analysis, the number of individuals with a BMI of 30 kg/m2 to 40 kg/m2 was a predictor of NASH waitlist additions (P < .01). However, on multivariate analysis, no individual BMI category was a significant predictor of NASH waitlist additions with a 9-year lag.
These results are, “worrisome in the setting of a plateauing donor supply, making receipt of a LT more difficult for those on the waitlist,” the researchers concluded. “Continued public health efforts to curb obesity prevalence and improvement in the diagnosis of and treatment of NASH will be important to mitigate the overall impact of our projections.” – by Talitha Bennett
Disclosure: The researchers report no relevant financial disclosures.