Liver Shorts: Relationship of Hepatic Steatosis to Cardiovascular Disease and the Cost of Liver Transplantation

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HS Ahmed et al. Hepatology 2023; 77: 2063-2072. The association between hepatic steatosis and incident cardiovascular disease, cancer, and all-cause mortality in a US multicohort study

The authors included 10,040 participants from the Framingham Heart Study, the Coronary Artery Risk Development in Young Adults Study, and the Multi-ethnic Study of Atherosclerosis to assess the longitudinal association between liver fat (defined on CT) and incident cardiovascular disease (CVD).

Key finding:

Hepatic steatosis was associated with all-cause mortality after 12.7 years of mean follow-up when adjusting for baseline CVD risk factors, including body mass index (HR: 1.21, 1.04–1.40); however, the association between hepatic steatosis and incident CVD was not statistically significant after we accounted for body mass index in models considering baseline covariates or time-varying covariates. We observed no association between hepatic steatosis and CVD-related mortality or incident cancer.

My take: While CVD is the leading cause of mortality in patients with fatty liver disease, this study suggests that hepatic steatosis is a marker for this increased risk rather than an independent cause.

DU Lee et al. Liver Transplantation 2023; 29: 626-643. The trends in cost associated with liver transplantation in the US: Analysis of weighted hospital data

This lengthy article is loaded with data on trends and costs of liver transplantation in the U.S.

Key findings:

  • From 2016 to 2019, the estimated total number of LT-related hospitalizations in the US were 6685, 7075, 7260, and 7815 cases respectively.
  • There was a general increase in the total cost of LT-related hospitalizations over the years: $945.75, $1010.23, $1052.46, and $1143.84 in millions of dollars.

Editorial: A Kaplan et al. Liver Transplantation 2023; 29: 568-569. Open Access!
Liver transplant at all costs Key points:

  • Mean costs per patient for transplant-related hospitalization were around $145,000.
  • “Lee and colleagues’ important study adds to the growing concern over rising costs for LT. However, LT is 1 of many fields that must utilize a scarce resource for the maximal benefit of society. Balancing costs with a life-saving procedure that is very expensive will continue to be a persistent challenge.”

My take: It is likely that the costs of liver transplantation are going to continue to rise unless we develop a shortage of suitable liver donors or a shortage of transplant personnel. Severe fatty liver disease and alcoholic liver disease continue to increase in frequency while hospital costs continue to soar. Reducing costs will rely on reversing the tide of these diseases.

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