Geographic Divergence in Waitlist Registration and Trends in Waitlist Removal for Liver Transplantation in Patients with Nonalcoholic Steatohepatitis (NASH)
1Internal Medicine - Transplant Hepatology, University of Southern California, Los Angeles, CA, 2Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MA
Meeting: 2021 American Transplant Congress
Abstract number: 1146
Keywords: Allocation, Liver, Liver transplantation, Waiting lists
Topic: Clinical Science » Liver » Liver: MELD, Allocation and Donor Issues (DCD/ECD)
Session Information
Session Name: Liver: MELD, Allocation and Donor Issues (DCD/ECD)
Session Type: Poster Abstract
Session Date & Time: None. Available on demand.
Location: Virtual
*Purpose: This study aims to evaluate regional trends of waitlist (WL) registrations and removal for liver transplantation (LT) among United States (US) adults listed for nonalcoholic steatohepatitis (NASH).
*Methods: We evaluated annual WL data for new transplant registrations listed for NASH in the US between January 1, 2004, and December 31, 2019 using deidentified data from the United Network for Organ Sharing (UNOS) LT database. Regional data was stratified as established by the Organ Procurement and Transplantation Network (OPTN).
*Results: Between 2004-2019, a total of 9,030 new WL registrations were listed for NASH, 53.6% (4,842) of which were registered between 2014 and 2019. New WL registration for NASH increased consistently over time, from 83 new WL registrations for NASH in 2004 to 1345 in 2019. A total of 8,415 registrations were removed from the WL during the study period. The most common reasons for WL removal were death (29.69%), deterioration of condition (26.69%), or improvement of condition (7.30%). Of patients who died before receiving LT, the most common causes of death were multiorgan failure (29.09%), sepsis (9.84%), or cardiovascular-related issues (8.76%).
*Conclusions: There has been a substantial increase in new WL registrations for patients with NASH since 2004 throughout all OPTN regions. Total number of NASH patients awaiting LT has more than doubled and new WL registration for NASH has increased precipitously since 2014, potentially due to increasing diagnostic awareness of NASH and the introduction of highly effective antiviral therapy for HCV. These trends are likely to diminish in the future as HCV infection nears eradication. Over 50% of NASH WL registrations were removed due to death or clinical deterioration. Among this group, common causes of death were multiorgan failure, sepsis, or cardiovascular comorbidity. Future efforts must identify ways to meet this increasing demand for NASH-related LT while more effectively identifying high-risk NASH patients awaiting LT to improve WL mortality.
To cite this abstract in AMA style:
Hanlon C, Saberi B, Yuan L. Geographic Divergence in Waitlist Registration and Trends in Waitlist Removal for Liver Transplantation in Patients with Nonalcoholic Steatohepatitis (NASH) [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/geographic-divergence-in-waitlist-registration-and-trends-in-waitlist-removal-for-liver-transplantation-in-patients-with-nonalcoholic-steatohepatitis-nash/. Accessed May 11, 2025.« Back to 2021 American Transplant Congress