Author information
1
(1) Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore and (2) Departments of Surgery & Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Abstract
BACKGROUND:
Patients with NASH cirrhosis have excellent post liver transplant (LT) survival despite having many co-morbidities. We hypothesized that this could be due to a selection bias.
METHODS:
We analyzed the UNOS data from 2002 to 2016 and compared post-LT survival of NASH (n=7,935) patients with cryptogenic (CC, n= 6,087), alcoholic AC, n=16,810) and autoimmune hepatitis (AIH, n= 2,734) cirrhosis.
RESULTS:
By 3 years of listing, the cumulative incidence (CI) of death or deterioration was 29% for NASH, 28% for CC and AC, and 24% for AIH, but when adjusted for risk factors, the CI was similar for NASH and AIH. The factors that increased the risk of waiting list removal due to death/deterioration were poor performance status, encephalopathy, diabetes, high MELD, Hispanic race, older age and a low serum albumin. Most patients were transplanted within the first year [median 2 months (1-7 IQR] of listing and by 5 years, the unadjusted CI of transplantation was 54% for NASH, 52% for CC, 51% for AIH and 48% for AC. The adjusted CI of transplantation within 2 months of listing was higher for AC (SHR 1.17), AIH (SHR 1.17) and CC (SHR 1.13) when compared to NASH, but after 2 months adjusted transplantation rates decreased in AC (SHR =0.6), AIH (0.78) and CC (SHR 0.95). The negative predictors of receiving a transplant were dialysis, female gender, non-White race, high albumin and creatinine.