Background: With the rising prevalence of alcoholism, obesity, and metabolic syndrome, steatohepatitis is projected to become the leading cause of end-stage liver disease and hepatocellular carcinoma (HCC) by 2025 in the United States.

Objective, Setting, and Design: Using a prospectively collected database, clinical features of all adult patients who underwent liver transplantation (LT) for steatohepatitis due to non-alcoholic (NASH) and alcoholic causes (ALD) between 1/1/02 and 8/31/11 were analyzed, including comparisons of patients with and without HCC in the explant pathology.

Results: HCC was present in 80 of 317 patients who underwent LT for steatohepatitis with equivalent distribution in NASH and ALD patients (24% vs 26%;P=0.8). On multivariate analysis, significant predictors of HCC included age, race, hyperlipidemia, and diabetes, but not BMI, hypertension, or smoking. (Table) Metformin, statins, and hypoglycemic agents did not have any significant independent effect on the occurrence of HCC.

Conclusions: We report the largest series of liver transplantation for HCC in steatohepatitis. Metabolic factors such as diabetes appear to play large promoting roles in non-viral mediated hepatocarcinogenesis. Current pharmacologic treatment of diabetes and hyperlipidemia does not seem to affect the incidence of this increasingly common obesity-related disease.

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