Publications & Reports

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.

Howell J, Balderson G, Hellard M, Gow PJ, Strasser SI, Stuart KA, Wigg A, Jeffrey G, Gane E, Angus PW
Liver Transplant Unit, Austin Hospital, Melbourne, Australia.

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 January 1, 1985 until December 31, 2012. Potentially preventable liver disease was defined as HBV, HCV, NAFLD, ALD and HCC. The aetiology 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 due to 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. CONCLUSION: Since 2004, the majority of primary adult liver transplants within Australia and New Zealand have been due to 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. This article is protected by copyright.

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Publication

  • Journal: Journal of gastroenterology and hepatology
  • Published: 01/02/2016
  • Volume: 31
  • Issue: 2
  • Pagination: 434-441

Authors

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