Non-alcoholic steatohepatitis (NASH) is the leading cause of liver transplant in US women while pregnancy rates in women with liver disease are also on the rise.

In an overview of ‘What’s new in hepatology’, delegates at Australian Gastroenterology Week 2018 were told that NASH was now the most common indication for waitlist registration and liver transplant in Asian, Hispanic and non-Hispanic white females in the US.

Hepatitis C as an indication for liver transplant had dropped dramatically since the advent of direct acting antivirals (DAAs) leaving alcoholic liver disease to take the number one spot overall and NASH the second leading indication overall.

When separated by gender, alcoholic liver disease remained the leading cause of liver transplants in men – for now – and NASH the leading indication in women.

The study of over 127,000 patients also found hepatocellular cancer (HCC) due to NASH had dramatically increased.

Dr Enoka Gonsalkorala, from the Royal Brisbane and Women’s Hospital, said local data showed a similar trend.

The Australian and New Zealand Liver Transplant Registry reported NASH as the primary diagnosis in adults had increased from 1% in 2000-2004 to 9% in 2015-2017.

Dr Gonsalkorala also highlighted the increasing numbers of women with liver cirrhosis having pregnancies.

In a UK study she co-authored, most women achieved a successful pregnancy outcome (75% live birth rate in women with cirrhosis, 85% in women without cirrhosis).

The study found a preconception albumin-bilirubin score (ALBI) predicted live births while the aspartate transaminase to platelet ratio index (APRI) predicted gestation beyond 37 weeks.

She said both scores could be used in preconception counseling.

In another study of 162 pregnancies following liver transplantation, acute cellular rejection occurred in 11 women during pregnancy and another eight women after delivery.

There were no episodes of pregnancy related graft loss.