Increased Risk of Death in First Year After Liver Transplantation Among Patients With Nonalcoholic Steatohepatitis vs Liver Disease of Other Etiologies

Abstract

This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e161. Learning Objective-Upon completion of this activity, successful learners will be able to learn recent outcome trends of liver transplantation, focusing on comparisons among major liver disease etiologies, including nonalcoholic steatohepatitis, hepatitis C cirrhosis, and alcoholic-related liver disease; and learn the importance of pre-transplant assessments and risk factors for poor post-transplant outcomes in patients with nonalcoholic steatohepatitis. BACKGROUND & AIMS: An increasing number of patients with non-alcoholic steatohepatitis (NASH) require liver transplantation. We compared outcomes of patients with liver diseases of different etiologies (NASH, hepatitis C virus [HCV]-associated liver disease, and alcohol-associated liver disease [ALD]). METHODS: We analyzed data from the United Network for Organ Sharing registry on 6344 patients who underwent liver transplantation for NASH, 17,037 for cirrhosis from chronic HCV infection, and 9279 for ALD. We collected data from patients who underwent liver transplantation during the following time periods:

NAFLD and liver transplantation: Disease burden, current management and future challenges

“…21 Despite these encouraging data, a recent American study reported a lower 1-year survival rate for NAFLD/NASH recipients compared to patients transplanted for HCV or alcohol-related liver disease, showing that the higher risk of death was mainly due to cardiovascular or cerebrovascular disease. 22 Considering all the metabolic complications potentially affecting patients after LT, the risk of developing post-transplant NAFLD/NASH can be considered high, although studies published on this topic are based on small sample sizes, with heterogeneous definitions of disease recurrence. 23 In a meta-analysis, the mean 1-, 3-, and 5-year incidence rates of recurrent and de novo NAFLD were 59%, 57%, 82% and 67%, 40%, 78%, respectively.…”

Aging and Chronic Liver Disease

“…74 Compared with patients younger than 50 years old, hazard ratios for overall mortality are 1.31 for patients 50 to 59 years old, 2.08 for patients 65 to 69 years old, and 2.66 for patients older than 70 years. 68,75 Cirrhosis. Advanced CLD is majorly diagnosed at advanced age, with an estimated mean age of 58 years old for patients with cirrhosis.…”

Pregnancy Weight Gain as a Predictor of Fetal Wellbeing in Liver Transplant Recipients

“…Pre-pregnancy BMI and gestational weight gain may be influenced by many factors, including parity, obesogenic environment, smoking, drugs, socioeconomic status, and accompanying diseases [ 6 ]. Patients undergoing liver transplantation are at greater risk of developing obesity than non-transplanted patients due to chronic disease, leading to transplantation problems, metabolic changes, immunosuppressive therapy, and other factors [ 7 , 8 ].…”