Outcomes of Liver Transplantation Among Older Recipients With Nonalcoholic Steatohepatitis in a Large Multicenter US Cohort: the Re‐Evaluating Age Limits in Transplantation Consortium

Abstract

The liver transplantation (LT) population is aging, with the need for transplant being driven by the growing prevalence of nonalcoholic steatohepatitis (NASH). Older LT recipients with NASH may be at an increased risk for adverse outcomes after LT. Our objective is to characterize outcomes in these recipients in a large multicenter cohort. All primary LT recipients ≥65 years from 2010 to 2016 at 13 centers in the Re-Evaluating Age Limits in Transplantation (REALT) consortium were included. Of 1023 LT recipients, 226 (22.1%) were over 70 years old, and 207 (20.2%) had NASH. Compared with other LT recipients, NASH recipients were older (68.0 versus 67.3 years), more likely to be female (47.3% versus 32.8%), White (78.3% versus 68.0%), Hispanic (12.1% versus 9.2%), and had higher Model for End-Stage Liver Disease-sodium (21 versus 18) at LT (P < 0.05 for all). Specific cardiac risk factors including diabetes with or without chronic complications (69.6%), hypertension (66.3%), hyperlipidemia (46.3%), coronary artery disease (36.7%), and moderate-to-severe renal disease (44.4%) were highly prevalent among NASH LT recipients. Graft survival among NASH patients was 90.3% at 1 year and 82.4% at 3 years compared with 88.9% at 1 year and 80.4% at 3 years for non-NASH patients (log-rank P = 0.58 and P = 0.59, respectively). Within 1 year after LT, the incidence of graft rejection (17.4%), biliary strictures (20.9%), and solid organ cancers (4.9%) were comparable. Rates of cardiovascular (CV) complications, renal failure, and infection were also similar in both groups. We observed similar posttransplant morbidity and mortality outcomes for NASH and non-NASH LT recipients. Certain CV risk factors were more prevalent in this population, although posttransplant outcomes within 1 year including CV events and renal failure were similar to non-NASH LT recipients.

Cardiovascular involvement after liver transplantation: role of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis

“…Thus, findings are far from being conclusive. While there is a general agreement that the metabolic alterations prevalent in NAFLD patients have an impact on death/removal during the LT waiting list, survival, CV events and renal failure rates were similar in NASH and non-NASH patients undergoing LT [30].…”

“…Future studies on the different ways of evaluating metabolic alterations in women compared to men are needed in consideration of the increased number of transplants performed in women. In fact, in recent years, non-alcoholic steatohepatitis (NASH) represents the leading cause of transplantation in the female population [30,31].…”

The 5Ms of Geriatrics in Gastroenterology: The Path to Creating Age-Friendly Care for Older Adults With Inflammatory Bowel Diseases and Cirrhosis

“…Improvements in cirrhosis care and expanded therapeutic options for older adults with cirrhosis are 2 leading factors explaining increased aging among patients with cirrhosis ( 13 , 14 , 55 , 56 ). In addition to the aging of the hepatitis C baby boomer birth cohort, there is also an increasing prevalence of non-alcoholic steatohepatitis and hepatocellular carcinoma, which disproportionately affect older adults ( 14 ).…”

Preoperative evaluation of geriatric patients undergoing liver transplantation

“…Some studies suggest that outcome of elderly patients receiving LT are comparable to younger patients, whereas other suggest that that median survival in elderly patients is lower than younger age group (18-59 years) [13][14][15]. Several scoring systems have been proposed for predicting longterm outcomes after LT.…”