Abstract
BackgroundSeveral trend analyses on liver transplantation (LT) indications have been published in the U.S. and in other countries, but there are limited data on LT indication trends in Saudi Arabia (SA), especially since the availability of direct-acting antivirals (DAAs) treatment for hepatitis C virus (HCV). This study aimed to analyze trends in the frequency of LT indications among LT recipients in SA over a 19-year period and examine associations between etiologic-specific trends and clinicodemographic characteristics.MethodsThis retrospective study analyzed clinical and surgical data of adult patients (n = 1009) who underwent LT at the King Faisal Specialist Hospital & Research Center (Riyadh, SA) between 2001 and 2019. Spearman’s rank correlation, Poisson regression, and Joinpoint regression analysis were employed to assess changes in LT etiologic trends.ResultsIn the first period (2001–2010), the main LT indications were HCV (41.9%) and hepatitis B virus (HBV) (21.1%), but nonalcoholic steatohepatitis (NASH) (29.7%) surpassed HCV (23.7%) as the leading LT indication in the second period (2011–2019); and the trends were significant in correlation analyses [incidence rate ratio (IRR) = 1.09 (1.06–1.13) for NASH; IRR = 0.93 (0.91–0.95) for HCV]. In the Joinpoint regression analysis, increases in NASH from 2006 to 2012 (+ 32.1%) were statistically significant, as were the decreases in HCV from 2004 to 2007 (− 19.6%) and from 2010 to 2019 (− 12.1%). Similar patterns were observed in LT etiological comparisons before and after the availability of DAAs and within hepatocellular carcinoma stratifications.ConclusionsTrends in the epidemiology of LT indications among LT recipients in SA have changed over a 19-year period. Most notably, NASH has eclipsed HCV in the country due to the effective treatment strategies for HCV. These trends in NASH now need an aggressive public health response to minimize and avert future onset of additional clinical and economic strains on health care systems and LT centers in SA.
Highlights
Several trend analyses on liver transplantation (LT) indications have been published in the U.S and in other countries, but there are limited data on LT indication trends in Saudi Arabia (SA), especially since the avail‐ ability of direct-acting antivirals (DAAs) treatment for hepatitis C virus (HCV)
Worldwide, chronic liver disease (CLD) is estimated to cause 2 million annual deaths [1]. Among those who die from CLD, half die from cirrhosis-associated complications, and the other half die from viral hepatitis (VH) or hepatocellular carcinoma (HCC)
Indications were extracted from electronic medical records and grouped into 8 categories: nonalcoholic steatohepatitis (NASH), HCV, hepatitis B virus (HBV), Wilson’s disease, primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH), schistosomiasis (SCH), and other (i.e., “other” was a composite variable created to group infrequent indications (< 2% of all LTs)
Summary
Several trend analyses on liver transplantation (LT) indications have been published in the U.S and in other countries, but there are limited data on LT indication trends in Saudi Arabia (SA), especially since the avail‐ ability of direct-acting antivirals (DAAs) treatment for hepatitis C virus (HCV). Chronic liver disease (CLD) is estimated to cause 2 million annual deaths [1]. Among those who die from CLD, half die from cirrhosis-associated complications, and the other half die from viral hepatitis (VH) or hepatocellular carcinoma (HCC). Before 2014, chronic hepatitis C virus (HCV) infection was the most common indication for non-HCC LT listing in the United States (U.S.) [3]. The 2018 Annual Report of the European LT Registry noted a sharp decline in VHrelated indications over the last 50 years, and the report projected that NASH will be the leading indication for LT in Europe within the decade [6]
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