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Abstract Details
Factors Impacting Survival in Those Transplanted for NASH Cirrhosis: Data From the NailNASH Consortium
Clin Gastroenterol Hepatol. 2023 Feb;21(2):445-455.e2. doi: 10.1016/j.cgh.2022.02.028.Epub 2022 Feb 18.
1Pritzker School of Medicine, University of Chicago, Chicago, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: mrinella@bsd.uchicago.edu.
2Division of Hepatology at Sandra Atlas Bass Center for Liver Diseases & Transplantation, Barbara and Zucker School of Medicine/Northwell Health, Manhasset, New York.
3University of California San Francisco, San Francisco, California.
4MedStar Georgetown Transplant Institute, Washington, District of Columbia.
5Baylor University Medical Center, Dallas, Texas.
6Northwestern University Feinberg School of Medicine, Chicago, Illinois.
7Department of Gastroenterology and Hepatology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York.
8Mayo Clinic, Rochester, Minnesota.
9University of Tennessee/Methodist University Hospital, Memphis, Tennessee.
10Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota.
11Centers for Disease Control and Prevention, Atlanta, Georgia.
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.