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Inferior Liver Transplant Outcomes in Patients with Nonalcoholic Steatohepatitis

32 Pages Posted: 10 Jan 2019

See all articles by Shunji Nagai

Shunji Nagai

Henry Ford Hospital - Transplant and Hepatobiliary Surgery

Kelly Collins

Henry Ford Health System - Transplant and Hepatobiliary Surgery

Lucy C. Chau

Henry Ford Health System - Transplant and Hepatobiliary Surgery

Mohamed Safwan

Henry Ford Health System - Transplant and Hepatobiliary Surgery

Michael Rizzari

Henry Ford Health System - Transplant and Hepatobiliary Surgery

Atsushi Yoshida

Henry Ford Health System - Transplant and Hepatobiliary Surgery

Marwan S. Abouljoud

Henry Ford Health System - Transplant and Hepatobiliary Surgery

Dilip Moonka

Henry Ford Health System - Henry Ford Hospital

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Abstract

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

Suggested Citation

Nagai, Shunji and Collins, Kelly and Chau, Lucy C. and Safwan, Mohamed and Rizzari, Michael and Yoshida, Atsushi and Abouljoud, Marwan S. and Moonka, Dilip, Inferior Liver Transplant Outcomes in Patients with Nonalcoholic Steatohepatitis (12/31/2018 14:06:42). Available at SSRN: https://ssrn.com/abstract=3309408

Shunji Nagai (Contact Author)

Henry Ford Hospital - Transplant and Hepatobiliary Surgery ( email )

Detroit, MI
United States

Kelly Collins

Henry Ford Health System - Transplant and Hepatobiliary Surgery

Detroit, MI
United States

Lucy C. Chau

Henry Ford Health System - Transplant and Hepatobiliary Surgery

Detroit, MI
United States

Mohamed Safwan

Henry Ford Health System - Transplant and Hepatobiliary Surgery

Detroit, MI
United States

Michael Rizzari

Henry Ford Health System - Transplant and Hepatobiliary Surgery

Detroit, MI
United States

Atsushi Yoshida

Henry Ford Health System - Transplant and Hepatobiliary Surgery

Detroit, MI
United States

Marwan S. Abouljoud

Henry Ford Health System - Transplant and Hepatobiliary Surgery

Detroit, MI
United States

Dilip Moonka

Henry Ford Health System - Henry Ford Hospital

Detroit
United States

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