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INTRODUCTION

  • Fatty liver disease (nonalcoholic)

  • Liver transplant is the second most frequent transplant in the United States after kidney transplant.

  • Since 1988, over 170,000 liver transplants have been performed in the United States. In 2019, almost 8900 liver transplants were performed in the United States. Of them, approximately 8400 were from deceased donors and 500 from live donors. Approximately 700 of these transplants involved pediatric recipients (age under 18). These numbers represent an increase with respect to the corresponding values from a decade earlier in 2009: approximately 6300 total liver transplants from 6100 deceased and 200 live donors. The number of pediatric cases was 772 in 2009.

  • However, the number of patients in the waitlist for a liver transplant increased almost 2-fold from 7322 in 1995. There are currently over 12,600 waitlist candidates for a liver transplant in the United States. Of these, approximately 370 are pediatric (under the age of 18 years).

  • The severity of liver disease and geographical location may affect the waiting times. The sickest patients have priority for the liver transplant.

  • It is estimated that billed charges for a liver transplant in the United States are, on average, $812,500, with approximately $30,000/year medication costs.

  • The most frequent indications for liver transplantation in U.S. adults are:

    • Alcoholic liver disease

    • Hepatitis C

    • Other frequent indications in adults include:

      • Idiopathic/autoimmune disease

      • Liver transplant is the second most frequent transplant in the United States after kidney transplant.

      • Fatty liver disease (nonalcoholic)

        • Nonalcoholic fatty liver disease, probably because of the increased prevalence of diabetes mellitus, obesity, and cardiovascular disease, is becoming progressively a prominent indication for liver transplant

      • Malignancy (hepatocellular carcinoma [HCC])/cirrhosis

    • Biliary atresia is the most common indication in children.

  • In the United States acute liver failure (ALF) accounts for 6-7% of total liver transplants each year. ALF is the most dramatic clinical situation in which liver transplantation is conducted.

  • Survival after liver transplantation in the United States is as follows:

    • The 20-year survival rate is around 50%.

  • Two out of 3 patients on the waiting list are over the age of 50. Sixty percent of the patients in the waiting list are male, 40% female. Almost 60% on the waiting list are ethnic minorities.

  • In the United States about 80,000 adults are living with a functioning liver graft.

  • In the United States 4 patients die every day waiting for a liver transplant. The major limitation to meeting the demand of transplants is the availability of donated organs.

  • In the United States the most frequent causes of cirrhosis are hepatitis C, alcohol-related liver disease, nonalcoholic fatty liver disease, and hepatitis B.

  • Cirrhosis, hepatitis B and C are major risk factors for primary liver malignancies.

  • HCC is the most common type of primary liver malignancy and most common cause of primary liver malignancy requiring transplant.

  • In the United States hepatitis C infection is the most common cause of HCC, while in Asia and developing countries, hepatitis B is the most common cause.

  • Novel ...

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