Liver transplantation

Abstract

Chronic liver disease (CLD) is a major health problem in the United States, affecting millions of Americans and resulting in large health care expenditures and economic losses. The incidence of newly diagnosed CLD in the United States is 72.3 per 100,000 population.1 The most common etiologies of CLD include hepatitis C virus (HCV) (57%), alcohol (24%), nonalcoholic fatty liver disease (NAFLD) (9.1%), and hepatitis B virus (HBV) (4.4%). Approximately 3.9 million Americans (1.8 % of the population) have been infected with HCV, and 70% or 2.7 million have evidence of chronic infection based on detection of serum HCV RNA.2 Fortunately, the incidence of new infections is decreasing from a peak of 100 cases per 100,000 in the 1980s to 20 cases per 100,000 or 40,000 new infections annually currently. Because HCV is a chronic infection, however, the projections are for a fourfold increase between 1990 and 2015 in the number of individuals with a 20-year history of HCV infection13 (Fig. 85.1). This is important because of the increased risk in this population of life-threatening complications of CLD and the development of hepatocellular carcinoma (HCC). Estimates are that 14 million Americans (7.4% of the population) 18 years and older meet established criteria for alcohol abuse or dependence, 1 and alcohol accounts for 28% of the deaths from CLD. © 2008 Springer New York.