title: Liver transplantation for nonalcoholic steatohepatitis: the new epidemic.
abstract: OBJECTIVE
  To analyze incidence, outcomes, and utilization of health care resources in liver transplantation (LT) for nonalcoholic steatohepatitis (NASH).
  
  
  BACKGROUND
  With the epidemic of obesity and metabolic syndrome in nearly 33% of the US population, NASH is projected to become the leading indication for LT in the next several years. Data on predictors of outcome and utilization of health care resources after LT in NASH is limited.
  
  
  METHODS
  We conducted an analysis from our prospective database of 144 adult NASH patients who underwent LT between December 1993 and August 2011. Outcomes and resource utilization were compared with other common indications for LT. Independent predictors of graft and patient survival were identified.
  
  
  RESULTS
  The average Model for End-Stage Liver Disease score was 33. The frequency of NASH as the primary indication for LT increased from 3% in 2002 to 19% in 2011 to become the second most common indication for LT at our center behind hepatitis C. NASH patients had significantly longer operative times (402 vs 322 minutes; P < 0.001), operative blood loss (18 vs 14 packed red blood cell units; P = 0.001), and posttransplant length of stay (35 vs 29 days; P = 0.032), but 1-, 3-, and 5-year graft (81%, 71%, 63%) and patient (84%, 75%, 70%) survival were comparable with other diagnoses. Age greater than 55 years, pretransplant intubation, dialysis, hospitalization, presence of hepatocellular carcinoma on explant, donor age greater than 55 years, and cold ischemia time greater than 550 minutes were significant independent predictors of survival for all patients, whereas body mass index greater than 35 was a predictor in NASH patients only.
  
  
  CONCLUSIONS
  We report the largest single institution experience of LT for NASH. Over a 10-year period, the frequency of LT for NASH has increased 5-fold. Although outcomes are comparable with LT for other indications, health care resources are stressed significantly by this new and increasing group of transplant candidates.
authors.affiliation: Dumont-UCLA Transplant and Liver Cancer Centers, Pfleger Liver Institute, Department of Surgery, Los Angeles, CA, USA.
authors.forename: Vatche G
authors.initials: VG
authors.lastname: Agopian
authors.forename: Fady M
authors.initials: FM
authors.lastname: Kaldas
authors.forename: Johnny C
authors.initials: JC
authors.lastname: Hong
authors.forename: Meredith
authors.initials: M
authors.lastname: Whittaker
authors.forename: Curtis
authors.initials: C
authors.lastname: Holt
authors.forename: Abbas
authors.initials: A
authors.lastname: Rana
authors.forename: Ali
authors.initials: A
authors.lastname: Zarrinpar
authors.forename: Henrik
authors.initials: H
authors.lastname: Petrowsky
authors.forename: Douglas
authors.initials: D
authors.lastname: Farmer
authors.forename: Hasan
authors.initials: H
authors.lastname: Yersiz
authors.forename: Victor
authors.initials: V
authors.lastname: Xia
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Hiatt
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
mesh_terms: D000328:Adult; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005234:Fatty Liver / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease; D061646:Operative Time; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome