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Nonalcoholic Steatohepatitis is the Most Rapidly Increasing Indication for Liver Transplantation in Young Adults in the United States

Doycheva, Iliana, MD*; Issa, Danny, MD; Watt, Kymberly, D., MD; Lopez, Rocio, MS§; Rifai, Ghassoub, MD; Alkhouri, Naim, MD

Journal of Clinical Gastroenterology: April 2018 - Volume 52 - Issue 4 - p 339–346
doi: 10.1097/MCG.0000000000000925

Goals: To analyze the frequency and trend of liver transplantation (LT) for nonalcoholic steatohepatitis (NASH) cirrhosis in young adults aged 18 to 40 years and to assess post-LT outcomes in this age group.

Background: NASH is currently the fastest-growing indication for LT in US adults. It is believed that NASH is a rare indication for LT among young adults.

Study: Using the United Network for Organ Sharing database, we performed a retrospective cohort analysis of all LTs in young adults between 2002 and 2012. Incidence rate ratio was calculated for each indication.

Results: A total of 5157 young adults underwent LT over the study period—54% were male, 23% obese. Mean (±SD) age and body mass index were 31.6±6.7 years and 26.3±6.1 kg/m2, respectively. The incidence of LTs performed for NASH cirrhosis increased from 0.53% in 2002 to 4.46% in 2012. NASH was the most rapidly growing indication for LT among all other etiologies with a 14% increment per year (incidence rate ratio, 1.14; 95% confidence interval, 1.09-1.20, P<0.001). The 5-year post-LT outcomes were comparable between NASH and non-NASH recipients, but graft survival was lower and retransplantation cumulative rates were higher in NASH recipients compared with those with other metabolic liver diseases (63.5% vs. 81.4%, P=0.003 and 12.7% vs. 4.2%, P=0.046, respectively).

Conclusions: NASH is the fastest-growing indication for LT among young US adults aged 18 to 40 years and now accounts for almost 5% of all LTs in this age group.

*Division of Gastroenterology and Hepatology, Medical University, Sofia, Bulgaria

Division of Gastroenterology, Virginia Commonwealth University, Richmond, VA

Gastroenterology and Hepatology Department, Mayo Clinic, Rochester, MN

§Department of Quantitative Health Sciences, Lerner Research Institute

Digestive Disease Institute, Cleveland Clinic, Cleveland, OH

Texas Liver Institute, San Antonio, TX

I.D.: interpretation of data, drafting of the manuscript, approved final submission. D.I., K.D.W., G.R.: critical revision of the manuscript, approved final submission. R.L.: statistical analysis, critical revision of the manuscript, approved final submission. N.A.: study concept and design, data analysis and interpretation, drafting of the manuscript, critical revision of the manuscript, approved final submission.

The authors declare that they have nothing to disclose.

Address correspondence to: Naim Alkhouri, MD, Metabolic Center, Texas Liver Institute, 607 Camden Street, San Antonio, TX, 78215 (e-mail:

Received March 23, 2017

Accepted July 20, 2017

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.