title: Equivalent survival following liver transplantation in patients with non-alcoholic steatohepatitis compared with patients with other liver diseases.
abstract: BACKGROUND
  Orthotopic liver transplantation (LT) in non-alcoholic steatohepatitis (NASH) is increasing in parallel with the obesity epidemic.
  
  
  METHODS
  This study retrospectively reviewed the clinical outcomes of LTs in NASH (n = 129) and non-NASH (n = 775) aetiologies carried out at a single centre between 1999 and 2009.
  
  
  RESULTS
  Rates of 1-, 3- and 5-year overall survival in NASH (90%, 88% and 85%, respectively) were comparable with those in non-NASH (92%, 86% and 80%, respectively) patients. Mortality within 4 months of LT was twice as high in NASH as in non-NASH patients (8.5% vs. 4.2%; P = 0.04). Compared with non-NASH patients, post-LT mortality in NASH patients was more commonly caused by infectious (38% vs. 26%; P < 0.05) or cardiac (19% vs. 7%; P < 0.05) aetiologies. Five-year survival was lower in NASH patients with a high-risk phenotype (age >60 years, body mass index >30 kg/m(2), with hypertension and diabetes) than in NASH patients without these characteristics (72% vs. 87%; P = 0.02). Subgroup analyses revealed that 5-year overall survival in NASH was equivalent to that in Laennec's cirrhosis (85% vs. 80%; P 0.87), but lower than that in cirrhosis of cryptogenic aetiology (85% vs. 96%; P = 0.04).
  
  
  CONCLUSIONS
  Orthotopic LT in NASH was associated with increased early postoperative mortality, but 1-, 3- and 5-year overall survival rates were equivalent to those in non-NASH patients.
authors.affiliation: Transplant Surgery, Division of Abdominal Transplant, Department of Surgery, University of Alabama, Birmingham, AL 35294-0007, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Kennedy
authors.forename: David
authors.initials: D
authors.lastname: Redden
authors.forename: Stephen
authors.initials: S
authors.lastname: Gray
authors.forename: Devin
authors.initials: D
authors.lastname: Eckhoff
authors.forename: Omar
authors.initials: O
authors.lastname: Massoud
authors.forename: Brendan
authors.initials: B
authors.lastname: McGuire
authors.forename: Basem
authors.initials: B
authors.lastname: Alkurdi
authors.forename: Joseph
authors.initials: J
authors.lastname: Bloomer
authors.forename: Derek A
authors.initials: DA
authors.lastname: DuBay
mesh_terms: D000328:Adult; D000368:Aged; D000407:Alabama; D002423:Cause of Death; D016009:Chi-Square Distribution; D005234:Fatty Liver / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008107:Liver Diseases / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome