Liver Transplantation for Nonalcoholic Steatohepatitis in the US: Temporal Trends and Outcomes
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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.
KeywordsFatty liver disease Hepatitis C virus Alcoholic liver disease Liver transplantation
Hepatitis C virus
Model for end-stage liver disease
United Network for Organ Sharing
Organ Procurement and Transplantation Network
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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