Changing Indication for Liver Transplantation: 10 Year Study

Background and Aims: Recently, there has been a considerable increase in patients with Non- alcoholic fatty liver disease (NAFLD/NASH). Currently, the global prevalence of NASH is estimated at 25%. Also, patients with NASH frequently have metabolic syndrome which affects their survival and outcome. We aimed to study the impact of this changing epidemiology in patients undergoing Liver Transplantation (LT) over a 10-year period and also factors that affect patient survival in those undergoing LT for NASH. Methodology: The study population was stratified in to Period 1 (2009-2014) and Period 2 (2015- 2019). Demographics, indications for LT and changes in the epidemiology between two time periods were analysed. Details of transplant, aetiology based post-transplant survival analysis was carried out at 1, 3 and 5 years. Results: Indication for LT among 1017 adult patients (277 in Period 1 and 740 in Period 2) showed a significant increase in NASH (85 (30.7%) and 311 (42%), P=0.001), decrease in hepatitis C (49 (17.7%) and 75 (10.1%), P=0.002). In HCV patients undergoing LT, we observed a significant increase in HCC from period 1 to period 2 (26.5% to 50.5%, P= 0.009). However, there was no difference in NASH related HCC between the two study periods [21.12% vs 19.9%, P=0.897). Patients in the NASH group were significantly older (56, 49.75-61 vs 49, 40 -56, P=0.000), with higher prevalence of diabetes mellitus, systemic hypertension and smoking. We also found a lower 5-year survival in those patients transplanted for NASH as compared with those transplanted for viral hepatitis (75.9% vs 87.4%, P=0.03). Conclusion: NASH is the leading indication for liver transplantation in India, surpassing viral hepatitis in the recent years.