Rising Rates of Hepatocellular Carcinoma Leading to Liver Transplantation in Baby Boomer Generation with Chronic Hepatitis C, Alcohol Liver Disease, and Nonalcoholic Steatohepatitis-Related Liver Disease.

George Cholankeril,Menghan Hu,Satheesh Nair,Eric Yoo,Andy Liu,Jeevin Sandhu,Aijaz Ahmed,Ryan Perumpail

doi:10.3390/diseases5040020

Abstract

We aim to study the impact of the baby boomer (BB) generation, a birth-specific cohort (born 1945–1965) on hepatocellular carcinoma (HCC)-related liver transplantation (LT) in patients with chronic hepatitis C virus (HCV), alcoholic liver disease (ALD), and non-alcoholic steatohepatitis (NASH). We performed a retrospective analysis using the United Network for Organ Sharing (UNOS)/Organ Procurement Transplant Network (OPTN) database from 2003 to 2014 to compare HCC-related liver transplant surgery trends between two cohorts—the BB and non-BB—with a secondary diagnosis of HCV, ALD, or NASH. From 2003–2014, there were a total of 8313 liver transplant recipients for the indication of HCC secondary to HCV, ALD, or NASH. Of the total, 6658 (80.1%) HCC-related liver transplant recipients were BB. The number of liver transplant surgeries for the indication of HCC increased significantly in NASH (+1327%), HCV (+382%), and ALD (+286%) during the study period. The proportion of BB who underwent LT for HCC was the highest in HCV (84.7%), followed by NASH (70.3%) and ALD (64.7%). The recommendations for birth-cohort specific HCV screening stemmed from a greater understanding of the high prevalence of chronic HCV and HCV-related HCC within BB. The rising number of HCC-related LT among BB with ALD and NASH suggests the need for increased awareness and improved preventative screening/surveillance measures within NASH and ALD cohorts as well.

Highlights

The incidence of hepatocellular carcinoma (HCC) has been rising at an alarming rate with over half a million new cases diagnosed annually worldwide [1]
The overall annual trends in HCC-related liver transplantation (LT) among baby boomers (BB) for hepatitis C virus (HCV), non-alcoholic steatohepatitis (NASH), and alcoholic liver disease (ALD) are depicted in LT was noted in NASH (+3.5%), followed by HCV (+2.6%), and ALD (+2.1%)
While previous studies have the number of HCC patients who underwent LT has risen significantly

Summary

Introduction

The incidence of hepatocellular carcinoma (HCC) has been rising at an alarming rate with over half a million new cases diagnosed annually worldwide [1]. Diseases 2017, 5, 20 most rapidly rising cause of cancer and cancer-related deaths with an incidence that has tripled over the last decade [2]. This rise in HCC incidence is largely due to the high prevalence of chronic hepatitis. Of HCV infection seen in baby boomers (BB), Americans born between 1945 and 1965 [4]. Due to their long-standing chronic HCV infection, this aging birth specific-cohort has a higher likelihood for developing HCC [5,6]. We aim to study the impact of the BB birth-specific cohort on LT recipients with HCV-related HCC, ALD-related HCC, and NASH-related HCC

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Conclusion