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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.
Austin Authors: Howell, Jessica;Balderson, Glenda;Hellard, Margaret;Gow, Paul;Strasser, Simone;Stuart, Katherine;Wigg, Alan;Jeffrey, Gary;Gane, Ed;Angus, Peter W 
Affiliation: Liver Transplant Unit, Austin Health, Heidelberg, Victoria, 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
Australia and New Zealand Liver Transplant Registry, Princess Alexandra Hospital, Brisbane, Australia
A W Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
Queensland Liver Transplant Unit, Princess Alexandra Hospital, Brisbane, Australia
South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, Australia
West Australian Liver Transplant Unit, Charles Gardiner Hospital, Perth, Australia
New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
Issue Date: Feb-2016
Publication information: Journal of Gastroenterology and Hepatology 2016; 31(2): 434-41
Abstract: 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. 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). 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. 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.
DOI: 10.1111/jgh.13082
PubMed URL: 26251217
Type: Journal Article
Subjects: epidemiology
liver cirrhosis
public health
Appears in Collections:Journal articles

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