Improved survival outcomes in patients with non‐alcoholic steatohepatitis and alcoholic liver disease following liver transplantation: an analysis of 2002–2012 United Network for Organ Sharing data

Abstract

There is an increasing trend of patients with hepatocellular carcinoma (HCC) and non-alcoholic fatty liver disease undergoing liver transplantation in the US. Our study utilized data from the 2002 to 2012 United Network for Organ Sharing registry to evaluate model for end-stage liver disease era trends in US liver transplantations focused on patients with non-alcoholic steatohepatitis (NASH), hepatitis C (HCV), alcoholic liver disease (ALD), and HCC. Survival outcomes were stratified by liver disease etiology and compared across time periods using Kaplan-Meier and Cox proportional hazards models. Patients with NASH were more likely to be women, had higher body mass index (BMI), and had higher prevalence of diabetes and cardiac disease. However, overall long-term survival was significantly higher in patients with NASH and ALD (p < 0.001). Compared to HCV, patients with NASH had significantly higher post-transplantation survival (HR 0.69, 95% CI 0.63-0.77), and lower risk of graft failure (HR 0.76, 95% CI 0.69-0.83). Despite having higher BMI and higher prevalence of diabetes and cardiac disease, patients with NASH had better post-liver transplantation survival compared to patients with HCV or HCC. Patients with ALD also had superior survival outcomes. However, these survival differences were limited to patients without HCC that underwent liver transplantation.

Evolution Of The Results Of 1500 Liver Transplantations Performed In The Department Of General, Transplant And Liver Surgery Medical University Of Warsaw

“…Infections with hepatotropic viruses, HCV and HBV, were the most common. According to reports by other authors, liver cirrhosis caused by chronic HCV infection is associated with relatively poorer long-term transplantation outcomes (2,22). Analysis of the material of our Department does not support such association (23).…”

Recommendations for Diagnosis, Referral for Liver Biopsy, and Treatment of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis

“…32 Studies evaluating long-term posttransplant survival in NASH patients show that survival is similar, or even superior, to those transplanted for other etiologies. 113, 114 Although graft loss is significantly lower in NASH patients, risk of cardiovascular death is much higher, 114 highlighting the importance of excellent preventative care following transplant. Patients transplanted for NASH cirrhosis also have a higher rate of chronic kidney disease after transplantation.…”

Nonalcoholic Fatty Liver Disease: Key Considerations Before and After Liver Transplantation

“…Several large database studies conducted over the last 5 years all report excellent survival rates in NASH patients (approximately 88 % at 1 year, 82 % at 3 years and 77 % at 5 years) [2, 9, 30]. These studies have employed both UNOS and SRTR data to compare survival rates between NASH and other indications for LT for patients transplanted between the late 1990s and early 2010s.…”

“…These studies have employed both UNOS and SRTR data to compare survival rates between NASH and other indications for LT for patients transplanted between the late 1990s and early 2010s. These studies all find comparable post-LT survival for NASH even with higher BMI, and higher prevalence of DM and CVD pre-LT [30]. …”