Equivalent survival following liver transplantation in patients with non-alcoholic steatohepatitis compared with patients with other liver diseases |
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Authors: | Christopher Kennedy David Redden Stephen Gray Devin Eckhoff Omar Massoud Brendan McGuire Basem Alkurdi Joseph Bloomer Derek A Dubay |
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Institution: | Transplant Surgery, Division of Abdominal Transplant, Department of Surgery Biostatistics Division, School of Public Health Transplant Hepatology, Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama, Birmingham, AL, USA. |
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Abstract: | BackgroundOrthotopic liver transplantation (LT) in non-alcoholic steatohepatitis (NASH) is increasing in parallel with the obesity epidemic.MethodsThis study retrospectively reviewed the clinical outcomes of LTs in NASH (n= 129) and non-NASH (n= 775) aetiologies carried out at a single centre between 1999 and 2009.ResultsRates of 1-, 3- and 5-year overall survival in NASH (90%, 88% and 85%, respectively) were comparable with those in non-NASH (92%, 86% and 80%, respectively) patients. Mortality within 4 months of LT was twice as high in NASH as in non-NASH patients (8.5% vs. 4.2%; P= 0.04). Compared with non-NASH patients, post-LT mortality in NASH patients was more commonly caused by infectious (38% vs. 26%; P < 0.05) or cardiac (19% vs. 7%; P < 0.05) aetiologies. Five-year survival was lower in NASH patients with a high-risk phenotype (age >60 years, body mass index >30 kg/m2, with hypertension and diabetes) than in NASH patients without these characteristics (72% vs. 87%; P= 0.02). Subgroup analyses revealed that 5-year overall survival in NASH was equivalent to that in Laennec''s cirrhosis (85% vs. 80%; P= 0.87), but lower than that in cirrhosis of cryptogenic aetiology (85% vs. 96%; P= 0.04).ConclusionsOrthotopic LT in NASH was associated with increased early postoperative mortality, but 1-, 3- and 5-year overall survival rates were equivalent to those in non-NASH patients. |
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