Relatively Poor Long-term Outcomes Following Liver Transplantation for NASH in the United States

Abstract

Background. Nonalcoholic steatohepatitis (NASH) continues to increase in frequency as an indication for liver transplantation (LT). Data on long-term outcomes for these patients are limited. We aimed to compare long-term patient and graft survival in patients undergoing LT for NASH in the United States to other indications. Methods. We analyzed data from the Scientific Registry of Transplant Recipients of adult patients who underwent primary deceased-donor LT from January 1, 2005, to December 31, 2019. Results. NASH has increased as an indication for LT by 4.5-fold, from 5.2% in 2005 to 23.4% in 2019. Patient (61.2%) and graft survival (59.2%) at 10 y are significantly poorer for NASH than for all other indications other than alcohol. Patients transplanted for NASH have higher body mass index (32.2 versus 27.6) and greater frequency of diabetes (13% versus 11.6%) than any other indication (P < 0.001). Portal vein thrombosis, location in intensive care unit, dialysis, and pre-LT diabetes (P < 0.001 for all) are independently predictive of patient death and graft loss. Body mass index is not predictive. NASH patients undergoing simultaneous liver kidney have markedly worse 10-y patient and graft survival than liver-only (52.3% versus 62.1%). Graft loss was attributed to recurrence of NASH in <1% of patients. Conclusions. LT for NASH is associated with relatively poor long-term patient and graft survival when compared with patients transplanted for other indications, NASH patients undergoing simultaneous liver kidney have the worst long-term outcomes.

Active coping, resilience, post-traumatic growth, and psychiatric symptoms among early and late liver transplant survivors

“…After 5 years, survivors may develop significant metabolic, renal complications, as well as potential recurrence of disease. Moreover, given that median post-LT survival exceeds 10 years, the ≥10-year survivorship period is an important time to consider risk for long-term complications including cardiovascular and malignant complications 28–30…”

“…Moreover, given that median post-LT survival exceeds 10 years, the ≥ 10-year survivorship period is an important time to consider risk for long-term complications including cardiovascular and malignant complications. [28][29][30] The main variables of interest included psychological traits and concepts (Table 1), which we suspect have important implications for survivorship but have not been well described in the literature for LT recipients. These included PTG, [16,18,41,42] resilience, [13,15,43,44] role of God/religion in controlling one's health, [45,46] and positive coping traits such as active coping.…”

Recurrent NAFLD post-LT: Sisyphus’ boulder or Proteus’ parable?

“…Morbidity and mortality in the context of NAFLD are predominantly from cardiovascular (CV) disease and malignancy, with liver-related mortality limited to those with significant fibrosis 3 . While short-term outcomes are comparable, transplants for NASH are associated with inferior long-term outcomes 1 . Increased attention to the management of metabolic comorbid disease before LT may reduce the risk of recurrence and adverse outcomes.…”

“…NASH is an increasingly common indication for liver transplantation (LT). [1,2] Recurrence of steatosis in the transplanted liver is nearly universal but is also seen de novo in those transplanted for other etiologies. Allograft steatosis is linked to metabolic burden, which can be further exacerbated by immunosuppression.…”

“…NASH is an increasingly common indication for liver transplantation (LT) 1,2 . Recurrence of steatosis in the transplanted liver is nearly universal but is also seen de novo in those transplanted for other etiologies.…”