Digestive Diseases and Sciences

, Volume 62, Issue 10, pp 2915–2922 | Cite as

Liver Transplantation for Nonalcoholic Steatohepatitis in the US: Temporal Trends and Outcomes

  • George Cholankeril
  • Robert J. Wong
  • Menghan Hu
  • Ryan B. Perumpail
  • Eric R. Yoo
  • Puneet Puri
  • Zobair M. Younossi
  • Stephen A. Harrison
  • Aijaz AhmedEmail author
Original Article


Background and Aims

Nonalcoholic steatohepatitis (NASH) is a rapidly growing etiology of end-stage liver disease in the US. Temporal trends and outcomes in NASH-related liver transplantation (LT) in the US were studied.


A retrospective cohort study utilizing the United Network for Organ Sharing and Organ Procurement and Transplantation (UNOS/OPTN) 2003–2014 database was conducted to evaluate the frequency of NASH-related LT. Etiology-specific post-transplant survival was evaluated with Kaplan–Meier methods and multivariate Cox proportional hazards models.


Overall, 63,061 adult patients underwent LT from 2003 to 2014, including 20,782 HCV (32.96%), 9470 ALD (15.02%), and 8262 NASH (13.11%). NASH surpassed ALD and became the second leading indication for LT beginning in 2008, accounting for 17.38% of LT in 2014. From 2003 to 2014, the number of LT secondary to NASH increased by 162%, whereas LT secondary to HCV increased by 33% and ALD increased by 55%. Due to resurgence in ALD, the growth in NASH and ALD was comparable from 2008 to 2014 (NASH +50.15% vs. ALD +41.87%). The post-transplant survival in NASH was significantly higher compared to HCV (5-year survival: NASH −77.81%, 95% CI 76.37–79.25 vs. HCV −72.15%, 95% CI 71.37–72.93, P < .001). In the multivariate Cox proportional hazards model, NASH demonstrated significantly higher post-transplant survival compared to HCV (HR 0.75; 95% CI 0.71–0.79, P < .001).


Currently, NASH is the most rapidly growing indication for LT in the US. Despite resurgence in ALD, NASH remains the second leading indication for LT.


Fatty liver disease Hepatitis C virus Alcoholic liver disease Liver transplantation 



Hepatitis C virus


Hepatocellular carcinoma


Liver transplantation


Model for end-stage liver disease


United Network for Organ Sharing


Organ Procurement and Transplantation Network


Author’s contribution

George Cholankeril, Robert J. Wong, Menghan Hu, and Ryan B. Perumpail helped in study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; and statistical analysis. Eric R. Yoo, Puneet Puri, Zobair M. Younossi, and Stephen A. Harrison contributed to analysis and interpretation of data and critical revision of the manuscript for important intellectual content. Aijaz Ahmed helped in study concept and design; analysis and interpretation of data; critical revision of the manuscript for important intellectual content; and study supervision.

Compliance with ethical standards

Conflicts of interest

None of the authors have any conflict of interests related to this publication.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyUniversity of Tennessee Health Sciences CenterMemphisUSA
  2. 2.Division of Gastroenterology and Hepatology, Alameda Health SystemHighland HospitalOaklandUSA
  3. 3.Department of BiostatisticsBrown University Public School of HealthProvidenceUSA
  4. 4.Division of Gastroenterology and Hepatology, Stanford University Medical CenterStanford University School of MedicinePalo AltoUSA
  5. 5.Department of MedicineUniversity of Illinois College of MedicineChicagoUSA
  6. 6.Division of Gastroenterology, Hepatology and NutritionVirginia Commonwealth UniversityRichmondUSA
  7. 7.Department of Medicine, Center for Liver DiseasesInova Fairfax HospitalFalls ChurchUSA
  8. 8.Betty and Guy Beatty Center for Integrated ResearchInova Health SystemFalls ChurchUSA
  9. 9.Radcliffe Department of MedicineUniversity of OxfordOxfordUK

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