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

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Abstract

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.

Methods

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.

Results

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).

Conclusions

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.

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Abbreviations

HCV:

Hepatitis C virus

HCC:

Hepatocellular carcinoma

LT:

Liver transplantation

MELD:

Model for end-stage liver disease

UNOS:

United Network for Organ Sharing

OPTN:

Organ Procurement and Transplantation Network

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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.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Tennessee Health Sciences Center, Memphis, TN, USA

    George Cholankeril

  2. Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA, USA

    Robert J. Wong

  3. Department of Biostatistics, Brown University Public School of Health, Providence, RI, USA

    Menghan Hu

  4. Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford University School of Medicine, 750 Welch Road, Suite 210, Palo Alto, CA, 94304, USA

    Ryan B. Perumpail & Aijaz Ahmed

  5. Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA

    Eric R. Yoo

  6. Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA

    Puneet Puri

  7. Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA

    Zobair M. Younossi

  8. Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA

    Zobair M. Younossi

  9. Radcliffe Department of Medicine, University of Oxford, Oxford, UK

    Stephen A. Harrison

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  1. George Cholankeril
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  9. Aijaz Ahmed
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Corresponding author

Correspondence to Aijaz Ahmed.

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Cholankeril, G., Wong, R.J., Hu, M. et al. Liver Transplantation for Nonalcoholic Steatohepatitis in the US: Temporal Trends and Outcomes. Dig Dis Sci 62, 2915–2922 (2017). https://doi.org/10.1007/s10620-017-4684-x

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  • DOI: https://doi.org/10.1007/s10620-017-4684-x

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