Increased Risk of Death in First Year After Liver Transplantation Among Patients with Nonalcoholic Steatohepatitis vs Liver Disease of Other Etiologies.

Authors:
Shunji Nagai
Shunji Nagai
Nagoya University Graduate School of Medicine
Japan
Kelly Collins
Kelly Collins
Loma Linda University
United States
Mohamed Safwan
Mohamed Safwan
Institute of Liver Disease and Transplantation
Michael Rizzari
Michael Rizzari
University of Minnesota
United States
Atsushi Yoshida
Atsushi Yoshida
School of Dentistry
Japan
Marwan S Abouljoud
Marwan S Abouljoud
Henry Ford Hospital
United States
Dilip Moonka
Dilip Moonka
Division of Gastroenterology
Gainesville | United States

Clin Gastroenterol Hepatol 2019 Apr 17. Epub 2019 Apr 17.

Gastroenterology, Henry Ford Hospital, Detroit, Michigan, United States.

Background & Aims: An increasing number of patients with non-alcoholic steatohepatitis (NASH) require liver transplantation. We compared outcomes of patients with liver diseases of different etiologies (NASH, hepatitis C virus [HCV]-associated liver disease, and alcohol-associated liver disease [ALD]).

Methods: We analyzed data from the United Network for Organ Sharing registry on 6344 patients who underwent liver transplantation for NASH, 17,037 for cirrhosis from chronic HCV infection, and 9279 for ALD. We collected data from patients who underwent liver transplantation during the following time periods: 2008-2010, 2011-2013, 2014-2015, 2016-2017. We compared outcomes of different groups using Cox regression models, adjusting for donor and recipient characteristics.

Results: For patients who underwent liver transplantation during 2016-2017, a significantly lower proportion of patients with NASH survived for 1 year after transplantation than patients with HCV (P=.004) or ALD (P<.001). During this time period, the adjusted risk of death within 1 year was significantly higher for patients with NASH than with ALD (hazard ratio, 1.37; P=.03), regardless of the presence of hepatocellular carcinoma. The effects of increasing age were greatest among patients with NASH: compared to patients younger than 50 years, hazard ratios for overall mortality were 1.31 for patients 50-59 years (P=.02), 1.66 for patients 60-64 years (P<.001), 2.08 for patients 65-69 years (P<.001), and 2.66 and for patients and ≥70 years (P<.001). Mortality from cardiovascular or cerebrovascular disease(s) was highest among patients with NASH, accounting for 11.5% of deaths, compared to 7.0% of deaths in patients with HCV infection and 9.6% in patients with ALD (P<.001).

Conclusions: In an analysis of data from patients who underwent liver transplantation during 2016-2017, we found the risk of death within 1 year after transplant was higher among patients with NASH than HCV-associated liver disease or ALD. Risk of death increased with age, and patients with NASH have a higher risk of death from cardiovascular or cerebrovascular disease.

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Source
https://linkinghub.elsevier.com/retrieve/pii/S15423565193042
Publisher Site
http://dx.doi.org/10.1016/j.cgh.2019.04.033DOI Listing
April 2019
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