Fatty liver disease may overtake HCV as key cause of liver transplant, AASLD president says

WASHINGTON — Once considered largely benign, fatty liver disease may overtake hepatitis C as the leading cause of liver transplant within 5 years, American Association for the Study of Liver Disease President J. Gregory Fitz, MD, said at The Liver Meeting opened here, particularly considering recent improvements in HCV therapies.

"Suddenly it’s realistic to think that we'll be able to cure most patients with hepatitis C" Fitz said, noting that almost simultaneously, however, fatty liver disease has moved from being considered “an incidental accompaniment of obesity or diabetes; now it’s crystal clear that this alone can go ahead and cause liver fibrosis and scarring and liver failure.”

Despite the rapid advances in HCV treatments which Fitz characterized as a "revolution,” he noted physicians still have an uphill battle ahead of them with the disease.

J. Gregory Fitz

“We’ve got some problems in front of us. Liver diseases are common despite the progress that’s been made. Liver diseases have gone from No. 14 as a cause of death about 10 years ago to now about No. 8,” he said.

Fitz also presented a selection of key presentations from The Liver Meeting, including several that reinforced his point with regard to the ongoing battle.

An analysis of U.S. Department of Veterans Affairs statistics by Lisa I. Backus, MD, for example, noted than one-third of veterans in the 1945-1965 birth cohort under VA care still have not been screened for HCV despite FDA guidelines that all individuals in the cohort be tested.

Extrapolating the numbers, it's likely there are more than 50,000 additional veterans with HCV under VA care who are unaware they have the disease, she said.

Another study by James W. Galbraith, MD, analyzed individuals in the same birth cohort who went to an emergency room for unrelated causes and agreed to an HCV screening. The study concluded one of eight Americans in the cohort may have HCV, he said.

The Galbraith study in particular stands as “a validation of that new CDC recommendation (of) 1945 to 1965,” Fitz said.