title: The increasing burden of potentially preventable liver disease among adult liver transplant recipients: A comparative analysis of liver transplant indication by era in Australia and New Zealand.
abstract: BACKGROUND
  Hepatitis C (HCV), hepatitis B (HBV), alcohol-related liver disease (ALD), and non-alcohol-related fatty liver disease (NAFLD) are leading indications for adult liver transplantation in Australia and New Zealand. However, these diseases are potentially preventable through effective primary and/or secondary prevention strategies. This study evaluates the relative contribution of potentially preventable liver diseases to liver transplant numbers in Australia and New Zealand over time.
  
  
  METHODS
  Prospectively recorded clinical, demographic, and outcome data were collected from the Australian and New Zealand Liver Transplant Registry for all primary adult liver transplants performed in Australia and New Zealand from 1 January 1985 until 31 December 2012. Potentially preventable liver disease was defined as HBV, HCV, NAFLD, ALD, and HCC. The etiology of liver disease leading to liver transplantation and the proportion of preventable liver disease-related liver transplantation was compared between Era 1 (1985-1993), Era 2 (1994-2003), and Era 3 (2004-2012).
  
  
  RESULTS
  Overall, 1252 of 3266 adult primary liver transplants (38.3%) were performed for potentially preventable liver disease. There was a significant increase in the proportion of liver transplants because of preventable liver disease from 21.2% (93 of 439) in Era 1, to 49.8% (623 of 1252) in Era 2 and 63.5% (1000 of 1575) in Era 3 (P < 0.0001). Over time, there was a significant increase in HCV (P < 0.0001), ALD (P = 0.002), and NAFLD (P < 0.0001) as a primary indication for adult liver transplant, whereas HBV has significantly decreased from Era 1 to Era 3 as an indication for transplant (P < 0.0001). The number of transplants performed for HCC also increased across Eras (P < 0.0001), with 84% due to underlying potentially preventable liver disease.
  
  
  CONCLUSIONS
  Since 2004, the majority of primary adult liver transplants within Australia and New Zealand have been because of potentially preventable liver diseases and the prevalence of these diseases has increased over time. This finding represents an opportunity for clinicians to make a significant impact on the overall burden of advanced liver disease in Australia and New Zealand by improving primary and secondary prevention measures.
authors.affiliation: Liver Transplant Unit, Austin Hospital, Melbourne, Australia.|Department of Medicine, University of Melbourne, Melbourne, Australia.|Centre for Population Health, MacFarlane-Burnet Institute, Melbourne, Australia.|Department of Medicine, Imperial College, London, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Howell
authors.affiliation: Australia and New Zealand Liver Transplant Registry, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Glenda
authors.initials: G
authors.lastname: Balderson
authors.affiliation: Centre for Population Health, MacFarlane-Burnet Institute, Melbourne, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Hellard
authors.affiliation: Liver Transplant Unit, Austin Hospital, Melbourne, Australia.|Department of Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Gow
authors.affiliation: A W Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Simone
authors.initials: S
authors.lastname: Strasser
authors.affiliation: Queensland Liver Transplant Unit, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Katherine
authors.initials: K
authors.lastname: Stuart
authors.affiliation: South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Wigg
authors.affiliation: West Australian Liver Transplant Unit, Charles Gardiner Hospital, Perth, Australia.
authors.forename: Gary
authors.initials: G
authors.lastname: Jeffrey
authors.affiliation: New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Ed
authors.initials: E
authors.lastname: Gane
authors.affiliation: Liver Transplant Unit, Austin Hospital, Melbourne, Australia.|Department of Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Angus
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D017281:Cost of Illness; D006498:Hepatectomy; D006526:Hepatitis C; D006801:Humans; D008107:Liver Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery*; D008108:Liver Diseases, Alcoholic; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D009520:New Zealand / Q000453:epidemiology; D065626:Non-alcoholic Fatty Liver Disease; D015995:Prevalence; D011322:Primary Prevention; D055502:Secondary Prevention; D013997:Time Factors; D055815:Young Adult
keywords: epidemiology; liver cirrhosis; prevention; public health; transplantation