Background and aims: Recently, there has been a considerable increase in patients with nonalcoholic fatty liver disease. Availability of high-efficacy drugs for hepatitis B and hepatitis C virus (HCV) infection may have changed the disease prevalence. We aimed to study the impact of this changing epidemiology in patients undergoing liver transplantation (LT) over a 10-year period.
Methods: The study population was stratified into Period 1 (2009-2014) and Period 2 (2015-2019). Demographics, indications for LT and changes in the epidemiology between two periods were analysed. Aetiology-based posttransplant survival analysis was carried out.
Results: Indication for LT among 1017 adult patients (277 in Period 1 and 740 in Period 2) showed a significant increase in nonalcoholic steatohepatitis (NASH; 85 [30.7%] and 311 [42%]; P = 0.001), decrease in hepatitis C (49 [17.7%] and 75 [10.1%]; P = 0.002), and increase in hepatocellular carcinoma from Period 1 to Period 2 (13 [26.5%] to 38 [50.7%]; P = 0.009) among HCV patients. Patients transplanted for NASH had a lower 5-year survival compared with viral hepatitis (75.9% vs 87.4%; P = 0.03). There was a strong association between coronary artery disease and NASH (hazard ratio = 1.963, 95% confidence interval, 1.19-3.22).
Conclusion: NASH is the leading indication for liver transplantation in India, surpassing viral hepatitis in recent years.
Keywords: ASH, Non-alcoholic steatohepatitis; CAD, Coronary artery disease; CLD, Chronic liver disease; DAA, Direct acting antiviral drugs; DM, Diabetes mellitus; HBV, Hepatitis B virus infection; HCC, Hepatocellular carcinoma; HCV, Hepatitis C virus infection; LT, Liver transplantation; NAFLD, Non-alcoholic fatty liver disease; SVR, Sustained virological response; cardiovascular disease; hepatocellular carcinoma; liver transplantation; nonalcoholic steatohepatitis; viral hepatitis.
© 2021 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.