Poor Survival after Retransplantation in NASH cirrhosis

ABSTRACTBackgroundNonalcoholic steatohepatitis (NASH) cirrhosis is a common indication for liver transplantation (LT) in the U.S. There is a paucity of data on retransplantation (re-LT) in those who were initially transplanted for NASH.MethodsWe queried the UNOS data sets from 2002-2016 to analyze the outcomes of adults with NASH (n=128) and compared them to groups that received re-LT for cryptogenic cirrhosis (CC, n=189), alcoholic cirrhosis (AC, n=300) or autoimmune hepatitis cirrhosis (AIH-C, n=118) after excluding multiple-organ re-LT and individuals with HCC. We estimated survival probabilities using a Kaplan-Meier estimator, and a relative risk of patient and graft mortality using proportional hazards regression.ResultsThe NASH group was older and had a higher prevalence of obesity, type II diabetes mellitus, renal insufficiency, portal vein thrombosis, and poor performance status. The median interval between 1st and 2nd LT was shorter in the NASH group (27 days). The graft and patient 5-year survival rates were lower for the NASH group after re-LT compared to the other 3 groups. After adjusting for demographic and disease complication factors, the factors that increased a risk of patient or graft failure were a poor performance status (HR=1.64 [1.19-2.26]), donor risk index (HR= 1.51 [1.08-2.12]) and a high MELD score (HR= 1.02 [1.00-1.04]).ConclusionsDespite the comparable outcomes reported for initial LT among the various etiologies, the outcome of re-LT is significantly worse for NASH cirrhosis. Background Nonalcoholic steatohepatitis (NASH) cirrhosis is a common indication for liver transplantation (LT) in the U.S. There is a paucity of data on retransplantation (re-LT) in those who were initially transplanted for NASH. Methods We queried the UNOS data sets from 2002-2016 to analyze the outcomes of adults with NASH (n=128) and compared them to groups that received re-LT for cryptogenic cirrhosis (CC, n=189), alcoholic cirrhosis (AC, n=300) or autoimmune hepatitis cirrhosis (AIH-C, n=118) after excluding multiple-organ re-LT and individuals with HCC. We estimated survival probabilities using a Kaplan-Meier estimator, and a relative risk of patient and graft mortality using proportional hazards regression. Results The NASH group was older and had a higher prevalence of obesity, type II diabetes mellitus, renal insufficiency, portal vein thrombosis, and poor performance status. The median interval between 1st and 2nd LT was shorter in the NASH group (27 days). The graft and patient 5-year survival rates were lower for the NASH group after re-LT compared to the other 3 groups. After adjusting for demographic and disease complication factors, the factors that increased a risk of patient or graft failure were a poor performance status (HR=1.64 [1.19-2.26]), donor risk index (HR= 1.51 [1.08-2.12]) and a high MELD score (HR= 1.02 [1.00-1.04]). Conclusions Despite the comparable outcomes reported for initial LT among the various etiologies, the outcome of re-LT is significantly worse for NASH cirrhosis. Address for correspondence: Avesh J. Thuluvath, M.D., Department of Medicine, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD 21224. Email: athuluv1@jhmi.edu Conflicts of interest: None Financial support: None Contributions: AJT contributed to the idea, YS did the statistical analysis, AJT, YS and PJT reviewed data, AJT, PHH, SK, YS and PJT wrote the manuscript, and all reviewed the final manuscript Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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