Gastroenterology

Gastroenterology

Volume 141, Issue 4, October 2011, Pages 1249-1253
Gastroenterology

Original Research
Clinical—Liver
Frequency and Outcomes of Liver Transplantation for Nonalcoholic Steatohepatitis in the United States

https://doi.org/10.1053/j.gastro.2011.06.061Get rights and content

Background & Aims

The relative frequency of nonalcoholic steatohepatitis (NASH) as an indication for liver transplantation and comparative outcomes following transplantation are poorly understood.

Methods

We analyzed the Scientific Registry of Transplant Recipients for primary adult liver transplant recipients from 2001 to 2009.

Results

From 2001 to 2009, 35,781 patients underwent a primary liver transplant, including 1959 for who NASH was the primary or secondary indication. The percentage of patients undergoing a liver transplant for NASH increased from 1.2% in 2001 to 9.7% in 2009. NASH is now the third most common indication for liver transplantation in the United States. No other indication for liver transplantation increased in frequency during the study period. Compared with other indications for liver transplantation, recipients with NASH are older (58.5 ± 8.0 vs 53.0 ± 8.9 years; P < .001), have a larger body mass index (>30 kg/m2) (63% vs 32%; P < .001), are more likely to be female (47% vs 29%; P < .001), and have a lower frequency of hepatocellular carcinoma (12% vs 19%; P < .001). Survival at 1 and 3 years after liver transplantation for NASH was 84% and 78%, respectively, compared with 87% and 78% for other indications (P = .67). Patient and graft survival for liver recipients with NASH were similar to values for other indications after adjusting for level of creatinine, sex, age, and body mass index.

Conclusions

NASH is the third most common indication for liver transplantation in the United States and is on a trajectory to become the most common. Outcomes for patients undergoing a liver transplant for NASH are similar to those for other indications.

Section snippets

Study Population

The study cohort included 35,781 adult patients (18 years of age or older) who underwent a liver transplant in the United States from January 1, 2001, to December 31, 2009. Each patient is only represented once in the cohort; thus, a second transplant during the study period was not included. Demographic, laboratory, radiologic, clinical, and surgical information was analyzed. Clinical data obtained at the time of transplant included age at transplant, sex, age, ethnicity, primary liver

Results

A total of 35,781 patients underwent a primary liver transplant from 2001 to 2009. NASH was documented as the primary or secondary indication for 1959 liver transplant recipients over the study period.

Discussion

Although the prevalences of NAFLD and NASH are quite well known, the frequency with which NASH results in cirrhosis with decompensation has been difficult to ascertain. One indication of the importance of NASH as a cause of end-stage liver disease is the frequency of NASH as an indication for liver transplantation, currently and over the course of time. The most important findings of this study are that NASH is the third most common indication for liver transplantation in the United States and

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    This article has an accompanying continuing education activity on page e22. Learning Objective: Upon completion of this CME exercise, successful learners will be able to review the comparative frequency, associations and outcomes of liver transplantation for NASH.

    Conflicts of interest The authors disclose no conflicts.

    Funding Supported by Public Health Service grant NIDDK R01 DK069757-01 and GCRC RR00585.

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