Rising Rate of Liver Transplantation in the Baby Boomer Generation with Non-alcoholic Steatohepatitis in the United States

摘要

Background and Aims:Nonalcoholic steatohepatitis (NASH) is the most rapidly growing indication for liver transplantation (LT) in the United States and is on a trajectory to become the leading indication for LT in the next decade.We aimed to study the trends in NASH-related LT among persons born between 1945 and 1965,the baby boomer (BB) generation.Methods:We performed a retrospective cohort analysis using population-based data from the United Network for Organ Sharing/Organ Procurement and Transplantation Network registry from 2004-2015 to evaluate the birth cohort-specific trends in liver transplant waitlist registrations and liver transplant surgeries in patients with NASH.We stratified our study population into three birth cohorts:1) birth before 1945,2) birth between 1945 and 1965,and 3) birth after 1965.Results:The overall rates of NASH-related waitlist registrations and liver transplant surgeries steadily increased from 2004 to 2015 and were reflective of a sharp rise noted in the NASH BB sub-group.From 2004 to 2015,the proportion of BB patients with NASH added to LT waitlist demonstrated an incremental growth,60.6％ in 2004 versus 83.2％ in 2015 (p ＜ 0.01).Among the liver transplant recipients with NASH,the proportion represented by the BB cohort increased from 56.3％ in 2004 to 80.0％ in 2015 (p ＜ 0.01).Conclusion:We report rising rates of waitlist registration and LT for the indication of NASH.More importantly,the BB sub-cohort was mainly responsible for these alarming trends.