Title

Factors Impacting Survival in Those Transplanted for NASH Cirrhosis: Data From the NailNASH Consortium

Authors

Mary E. Rinella, Pritzker School of Medicine, University of Chicago, Chicago, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: mrinella@bsd.uchicago.edu.
Sanjaya K. Satapathy, Division of Hepatology at Sandra Atlas Bass Center for Liver Diseases & Transplantation, Barbara and Zucker School of Medicine/Northwell Health, Manhasset, New York.
Danielle Brandman, University of California San Francisco, San Francisco, California.
Coleman Smith, MedStar Georgetown Transplant Institute, Washington, District of Columbia.
Sal Elwir, Baylor University Medical Center, Dallas, Texas.
Jonathan Xia, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Meg Gibson, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Carlos Figueredo, Department of Gastroenterology and Hepatology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York.
Mounika Angirekula, Mayo Clinic, Rochester, Minnesota.
Jason M. Vanatta, University of Tennessee/Methodist University Hospital, Memphis, Tennessee.
Raiya Sarwar, Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota.
Yu Jiang, University of Tennessee/Methodist University Hospital, Memphis, Tennessee.
Dyanna Gregory, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Tandy Agostini, MedStar Georgetown Transplant Institute, Washington, District of Columbia.
JimIn Ko, MedStar Georgetown Transplant Institute, Washington, District of Columbia.
Pradeep Podila, Centers for Disease Control and Prevention, Atlanta, Georgia.
Grace Gallo, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Kymberly D. Watt, Mayo Clinic, Rochester, Minnesota.
Mohammad S. Siddiqui, Virginia Commonwealth University, Richmond, Virginia.

Abstract

BACKGROUND & AIMS: Nonalcoholic steatohepatitis (NASH) is the leading indication for liver transplant (LT) in women and the elderly. Granular details into factors impacting survival in this population are needed to optimize management and improve outcomes. METHODS: Patients receiving LT for NASH cirrhosis from 1997 to 2017 across 7 transplant centers (NailNASH consortium) were analyzed. The primary outcome was all-cause mortality, and causes of death were enumerated. All outcomes were cross referenced with United Network for Organ Sharing and adjudicated at each individual center. Cox regression models were constructed to elucidate clinical factors impacting mortality. RESULTS: Nine hundred thirty-eight patients with a median follow-up of 3.8 years (interquartile range, 1.60-7.05 years) were included. The 1-, 3-, 5-, 10-, and 15-year survival of the cohort was 93%, 88%, 83%, 69%, and 46%, respectively. Of 195 deaths in the cohort, the most common causes were infection (19%), cardiovascular disease (18%), cancer (17%), and liver-related (11%). Inferior survival was noted in patients >65 years. On multivariable analysis, age >65 (hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.04-2.77; P = .04), end-stage renal disease (HR, 1.55; 95% CI, 1.04-2.31; P = .03), black race (HR, 5.25; 95% CI, 2.12-12.96; P = .0003), and non-calcineurin inhibitors-based regimens (HR, 2.05; 95% CI, 1.19-3.51; P = .009) were associated with increased mortality. Statin use after LT favorably impacted survival (HR, 0.38; 95% CI, 0.19-0.75; P = .005). CONCLUSIONS: Despite excellent long-term survival, patients transplanted for NASH at >65 years or with type 2 diabetes mellitus at transplant had higher mortality. Statin use after transplant attenuated risk and was associated with improved survival across all subgroups, suggesting that careful patient selection and implementation of protocol-based management of metabolic comorbidities may further improve clinical outcomes.

Publication Title

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

Share

COinS