Cardiovascular mortality among liver transplant recipients with nonalcoholic steatohepatitis in the United States—a retrospective study |
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Authors: | Sanjaya K. Satapathy Yu Jiang James D. Eason Satish K. Kedia Emily Wong Ashwani K. Singal Elizabeth A. Tolley Donna Hathaway Satheesh Nair Jason M. Vanatta |
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Affiliation: | 1. Department of Surgery, Methodist University Hospital Transplant Institute, University of Tennessee Health Sciences Center, Memphis, TN, USA;2. Division of Epidemiology, Biostatistics, & Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA;3. Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA;4. Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA;5. Department of Biostatistics and Epidemiology, University of Tennessee Health Sciences Center, Memphis, TN, USA;6. Department of Advanced Practice and Doctoral Studies, University of Tennessee Health Sciences Center, Memphis, TN, USA |
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Abstract: | Nonalcoholic steatohepatitis (NASH) has become an increasingly important indication for liver transplantation (LT), and there has been a particular concern of excessive cardiovascular‐related mortality in this group. Using the United Network for Organ Sharing‐Standard Transplant Analysis and Research (UNOS STAR) dataset, we reviewed data on 56,995 adult transplants (January 2002 through June 2013). A total of 3,170 NASH liver‐only recipients were identified and were matched with 3,012 non‐NASH HCV+ and 3,159 non‐NASH HCV? controls [matched 1:1 based on gender, age at LT (±3 years), and MELD score (±3)]. Cox regression analysis revealed significantly lower hazard of all‐cause (HR 0.669; P < 0.0001) and cardiovascular‐related mortality (HR 0.648; P < 0.0001) in the NASH compared to the non‐NASH group after adjusting for diabetes, BMI, and race. Relative to the non‐NASH HCV‐positive group, NASH group has lower hazard of all‐cause (HR 0.539; P < 0.0001) and cardiovascular‐related mortality (HR 0.491; P < 0001). A lower hazard of all‐cause mortality (HR 0.844; P = 0.0094) was also observed in NASH patients compared to non‐NASH HCV‐negative group, but cardiovascular mortality was similar (HR 0.892; P = 0.3276). LT recipients with NASH have either lower or similar risk of all‐cause and cardiovascular‐related mortality compared to its non‐NASH counterparts after adjusting for diabetes, BMI, and race. |
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Keywords: | cardiovascular mortality liver transplant nonalcoholic steatohepatitis survival United Network for Organ Sharing‐Standard Transplant Analysis and Research dataset |
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