title: Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States.
abstract: OBJECTIVE
  Nonalcoholic steatohepatitis (NASH) has been predicted to become the leading indication for liver transplantation (LT) in the United States. However, few studies have evaluated changes in the etiology of liver diseases among patients awaiting LT, and none have focused on the effects of NASH on liver transplant waitlists in the United States.
  
  
  METHODS
  We collected data from the United Network for Organ Sharing and Organ Procurement and Transplantation Network registry from 2004 through 2013, on liver transplant waitlist registrants with hepatitis C virus (HCV) infection, NASH, alcoholic liver disease (ALD), or a combination of HCV infection and ALD. We compared differences in survival within 90 days of registration (90-day survival) and probability of LT among patients with different diseases using Kaplan-Meier and multivariate logistic regression models.
  
  
  RESULTS
  Between 2004 and 2013, new waitlist registrants with NASH increased by 170% (from 804 to 2174), with ALD increased by 45% (from 1400 to 2024), and with HCV increased by 14% (from 2887 to 3291); registrants with HCV and ALD decreased by 9% (from 880 to 803). In 2013, NASH became the second-leading disease among liver transplant waitlist registrants, after HCV. Patients with ALD had a significantly higher mean Model for End-Stage Liver Disease score at time of waitlist registration than other registrants. However, after multivariate adjustment, patients with ALD were less likely to die within 90 days when compared with patients with NASH (odds ratio [OR] = 0.77; 95% confidence interval [CI]: 0.67-0.89; P < .001); patients with HCV infection or HCV and ALD had similar odds for 90-day survival compared with NASH patients. Compared with patients with NASH, patients with HCV (OR = 1.45; 95% CI: 1.35-1.55; P < .001), ALD (OR = 1.15; 95% CI: 1.06-1.24; P < .001), or HCV and ALD (OR = 1.29; 95% CI: 1.18-1.42; P < .001) had higher odds for 90-day survival.
  
  
  CONCLUSIONS
  Based on data from US adult LT databases, since 2004 the number of adults with NASH awaiting LTs has almost tripled. However, patients with NASH are less likely to undergo LT and less likely to survive for 90 days on the waitlist than patients with HCV, ALD, or HCV and ALD.
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital Campus, Oakland, California. Electronic address: rowong@alamedahealthsystem.org.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wong
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital Campus, Oakland, California.
authors.forename: Maria
authors.initials: M
authors.lastname: Aguilar
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California; Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
authors.forename: Ramsey
authors.initials: R
authors.lastname: Cheung
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California.
authors.forename: Ryan B
authors.initials: RB
authors.lastname: Perumpail
authors.affiliation: Division of Gastroenterology, Department of Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Harrison
authors.affiliation: Center of Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia.
authors.forename: Zobair M
authors.initials: ZM
authors.lastname: Younossi
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California.
authors.forename: Aijaz
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D004931:Esophageal Achalasia / Q000235:genetics*; D052138:Genes, Neoplasm / Q000235:genetics*; D006519:Hepatitis, Alcoholic / Q000276:immunology*; D006801:Humans; D016031:Liver Transplantation / Q000639:trends*; D052248:Nitric Oxide Synthase Type I / Q000235:genetics*; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology*; D010190:Pancreatic Neoplasms / Q000235:genetics*
chemical_list: C496320:NOS1 protein, human; D052248:Nitric Oxide Synthase Type I
keywords: Fatty Liver; MELD; UNOS/OPTN; Waitlist Mortality