Waiting List Mortality and Transplant Rates for NASH Cirrhosis When Compared to Cryptogenic, Alcoholic or AIH Cirrhosis

Background Patients with NASH cirrhosis have excellent post liver transplant (LT) survival despite having many co-morbidities. We hypothesized that this could be due to a selection bias. Methods We analyzed the UNOS data from 2002 to 2016 and compared post-LT survival of NASH (n=7,935) patients with cryptogenic (CC, n= 6,087), alcoholic AC, n=16,810) and autoimmune hepatitis (AIH, n= 2,734) cirrhosis. Results By 3 years of listing, the cumulative incidence (CI) of death or deterioration was 29% for NASH, 28% for CC and AC, and 24% for AIH, but when adjusted for risk factors, the CI was similar for NASH and AIH. The factors that increased the risk of waiting list removal due to death/deterioration were poor performance status, encephalopathy, diabetes, high MELD, Hispanic race, older age and a low serum albumin. Most patients were transplanted within the first year [median 2 months (1-7 IQR] of listing and by 5 years, the unadjusted CI of transplantation was 54% for NASH, 52% for CC, 51% for AIH and 48% for AC. The adjusted CI of transplantation within 2 months of listing was higher for AC (SHR 1.17), AIH (SHR 1.17) and CC (SHR 1.13) when compared to NASH, but after 2 months adjusted transplantation rates decreased in AC (SHR =0.6), AIH (0.78) and CC (SHR 0.95). The negative predictors of receiving a transplant were dialysis, female gender, non-White race, high albumin and creatinine. Conclusions Patients with NASH cirrhosis are not disadvantaged by higher waitlist removal or lower transplantation rates. Address for correspondence: Paul J. Thuluvath, MD, FAASLD, FRCP, Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD 21202. Tel: 410 332 9308; Fax: 410 659 1178; Email: thuluvath@gmail.com Conflicts of interest: None; Financial support: None Contributions: PJT and SH contributed to the idea, YS did the statistical analysis, PJT wrote the manuscript, SH and YS reviewed the final manuscript Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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