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Outcomes of Liver Transplantation for Non-alcoholic Steatohepatitis: a European Liver Transplant Registry Study

Haldar, D; Kern, B; Hodson, J; James Armstrong, M; Adam, R; Berlakovich, G; Fritz, J; ... European Liver, Intestine Transplant Association (ELITA); + view all (2019) Outcomes of Liver Transplantation for Non-alcoholic Steatohepatitis: a European Liver Transplant Registry Study. Journal of Hepatology , 71 (2) pp. 313-322. 10.1016/j.jhep.2019.04.011. Green open access

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Abstract

BACKGROUND & AIMS: Little is known about outcomes of liver transplantation for patients with non-alcoholic steatohepatitis (NASH). We aimed to determine the frequency and outcomes of liver transplantation for patients with NASH in Europe and identify prognostic factors. METHODS: We analyzed data from patients transplanted for end-stage liver disease between January 2002 and December 2016 using the European Liver Transplant Registry database. We compared data between patients with NASH versus other etiologies. The principle endpoints were patient and overall allograft survival. RESULTS: Among 68,950 adults undergoing first liver transplantation, 4.0% were transplanted for NASH - an increase from 1.2% in 2002 to 8.4% in 2016. A greater proportion of patients transplanted for NASH (39.1%) had hepatocellular carcinoma (HCC) than non-NASH patients (28.9%, P<.001). NASH was not significantly associated with survival of patients (HR 1.02, P=.713) or grafts (HR 0.99; P=.815) after accounting for available recipient and donor variables. Infection (24.0%) and cardio/cerebrovascular complications (5.3%) were the commonest causes of death in NASH patients without HCC. Increasing recipient age (61-65 years: HR 2.07, P<.001; >65: HR 1.72, P=.017), elevated MELD (>23: HR 1.48, P=.048) and low (<18.5kg.m-2: HR 4.29, P=.048) or high (>40kg.m-2: HR 1.96, P=.012) recipient BMI independently predicted death in patients transplanted for NASH without HCC. Data must be interpreted in the context of absent recognised confounders, such as pre-morbid metabolic risk factors. CONCLUSIONS: The number and proportion of liver transplants performed for NASH in Europe has increased from 2002 through 2016. HCC was more common in patients transplanted with NASH. Survival of patients and grafts in patients with NASH is comparable to that of other disease indications. LAY SUMMARY: NASH is a growing indication for liver transplantation in Europe, with good overall outcomes, although careful assessment for risk factors is required to maintain favorable post-transplant outcomes.

Type: Article
Title: Outcomes of Liver Transplantation for Non-alcoholic Steatohepatitis: a European Liver Transplant Registry Study
Location: Netherlands
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jhep.2019.04.011
Publisher version: http://doi.org/10.1016/j.jhep.2019.04.011
Language: English
Additional information: Copyright © The Author(s), 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed.
Keywords: ELTR database, etiology, long-term follow up, prognosis
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
URI: https://discovery.ucl.ac.uk/id/eprint/10074238
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