Inferior Liver Transplant Outcomes in Patients with Nonalcoholic Steatohepatitis
32 Pages Posted: 10 Jan 2019More...
Background: Non-alcoholic steatohepatitis (NASH) is an increasing indication for liver transplantation (LT). Post-transplant outcomes were evaluated among major etiologies (NASH, hepatitis C virus infection [HCV], and alcoholic liver disease [ALD]) to determine risks in LT associated with the NASH population.
Methods: Data from the UNOS registry were analyzed. Study period was divided into four groups by era: Era 1: 2008-2010, Era 2: 2011-2013, Era 3: 2014-2015, Era 4: 2016-2017. Patient outcomes were compared among disease groups using Cox regression models adjusting risks for donor and recipient characteristics.
Findings: There were 6,344 patients with NASH, 17,037 with HCV, and 9,279 with ALD. In Era 1, the HCV group showed significantly worse one-year patient survival rate of 87·4% compared to 90·3% for the NASH (P=0·007) and 90·6% for the ALD groups (P<0·001). By Era 4, the NASH group showed significantly worse survival rate at 90·4% compared to 92·8% for the HCV (P=0·004) and 93·5% for the ALD groups (P<0·001). The risk of one-year mortality in the NASH group became significantly higher than the HCV and ALD groups in Era 4 with hazard ratios of 1·30 (P=0·046) and 1·54 (P<0·001). The NASH group contained the fastest growing population of older patients and the effects of increasing age were most pronounced in the NASH group. Compared to patients <50 years, the hazard of overall mortality in age 50-59, 60-64, 65-69 and 70+ was 1·32 (P=0·02) 1·64 (P<0·001), 2·05 (P<0·001), and 2·61 (P<0·001). Mortality from cardiovascular/cerebrovascular disease(s) was greater in the NASH group accounting for 11·5% of deaths compared to 7·0% and 9·6% in HCV and ALD group (P<0·001).
Interpretation: The risk of post-transplant mortality and graft loss in the NASH population has become higher than in HCV or ALD. This is likely to have profound implications in a time of shifting indications for LT.
Funding Statement: This work received no funding from any agency in the public, commercial, or not-forprofit sectors
Declaration of Interests: The authors state: "nothing to disclose."
Ethics Approval Statement: Missing
Keywords: liver transplantation; non-alcoholic steatohepatitis; hepatitis C; alcoholic liver disease; direct-acting antiviral; Organ Procurement and Transplantation Network; United Network for Organ Sharing; cardiovascular/cerebrovascular disease; obesity; diabetes; aging; elderly
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