title: Improved survival outcomes in patients with non-alcoholic steatohepatitis and alcoholic liver disease following liver transplantation: an analysis of 2002-2012 United Network for Organ Sharing data.
abstract: There is an increasing trend of patients with hepatocellular carcinoma (HCC) and non-alcoholic fatty liver disease undergoing liver transplantation in the US. Our study utilized data from the 2002 to 2012 United Network for Organ Sharing registry to evaluate model for end-stage liver disease era trends in US liver transplantations focused on patients with non-alcoholic steatohepatitis (NASH), hepatitis C (HCV), alcoholic liver disease (ALD), and HCC. Survival outcomes were stratified by liver disease etiology and compared across time periods using Kaplan-Meier and Cox proportional hazards models. Patients with NASH were more likely to be women, had higher body mass index (BMI), and had higher prevalence of diabetes and cardiac disease. However, overall long-term survival was significantly higher in patients with NASH and ALD (p < 0.001). Compared to HCV, patients with NASH had significantly higher post-transplantation survival (HR 0.69, 95% CI 0.63-0.77), and lower risk of graft failure (HR 0.76, 95% CI 0.69-0.83). Despite having higher BMI and higher prevalence of diabetes and cardiac disease, patients with NASH had better post-liver transplantation survival compared to patients with HCV or HCC. Patients with ALD also had superior survival outcomes. However, these survival differences were limited to patients without HCC that underwent liver transplantation.
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wong
authors.forename: Christina
authors.initials: C
authors.lastname: Chou
authors.forename: Clark A
authors.initials: CA
authors.lastname: Bonham
authors.forename: Waldo
authors.initials: W
authors.lastname: Concepcion
authors.forename: Carlos O
authors.initials: CO
authors.lastname: Esquivel
authors.forename: Aijaz
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000150:complications / Q000401:mortality* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000401:mortality* / Q000601:surgery; D011183:Postoperative Complications; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: hepatitis C; hepatocellular carcinoma; model for end-stage liver disease; non-alcoholic steatohepatitis