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Digestive Disease Interventions 2020; 04(02): 223-234
DOI: 10.1055/s-0040-1713369
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Both Alcoholic and Nonalcoholic Steatohepatitis Is an Emerging Indication for Liver Transplantation in the United States

Danielle Fritze 
1   University Transplant Center, UT Health San Antonio, San Antonio, Texas
,
Amandeep Singh 
2   Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio
,
Eric Lawitz
1   University Transplant Center, UT Health San Antonio, San Antonio, Texas
3   Texas Liver Institute, San Antonio, Texas
,
Kris V. Kowdley
4   Liver Care Network and Organ Care Research, Swedish Medical Center, Seattle, Washington
,
Glenn Halff
1   University Transplant Center, UT Health San Antonio, San Antonio, Texas
,
Francisco Cigarroa
1   University Transplant Center, UT Health San Antonio, San Antonio, Texas
,
Tarunjeet Klair
1   University Transplant Center, UT Health San Antonio, San Antonio, Texas
,
Rocio Lopez
2   Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio
,
Mazen Noureddin
5   Department of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California
,
Naim Alkhouri
1   University Transplant Center, UT Health San Antonio, San Antonio, Texas
3   Texas Liver Institute, San Antonio, Texas
› Author Affiliations Funding None.
Further Information

Publication History

21 January 2020

24 April 2020

Publication Date:
03 July 2020 (online)

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Abstract

Background Nonalcoholic steatohepatitis (NASH) and alcoholic liver disease (ALD) are now the most common indications for liver transplantation (LT) in the United States. A subset of patients have both alcoholic and nonalcoholic steatohepatitis (BASH). This study characterizes patients with BASH requiring LT and assesses changes in the prevalence of BASH as an indication for LT.

Methods The United Network for Organ Sharing database was analyzed for all patients ≥ 18 years of age who received their first deceased donor LT from 2002 to 2016 for ALD, NASH, or BASH. Baseline demographics, clinical parameters, and LT outcomes were compared between groups.

Results Since 2002, 85,448 patients underwent LT:15,327 had ALD, 9,971 had NASH, and 2,779 had BASH. The prevalence of BASH as an indication for LT increased from 0.5% in 2002 to 5% in 2016. Compared with patients with NASH, those with BASH were significantly more likely to be male (85.6 vs. 57%), younger (mean 56.4 vs. 58.6 years), and Hispanic (22.2 vs. 13.6%) (p < 0.001 for all). While indication for transplant was not significantly associated with transplant outcomes on multivariable analysis, patient and graft survival curves do differ significantly by indication for transplant, with worse outcomes for patients with BASH (patient survival at 5 years: NASH 78.1%, ALD 77.2%, BASH 73.5%, p = 0.013; graft survival at 5 years: NASH 75.3%, ALD 74.0%, BASH 70.8%, p = 0.046).

Conclusions BASH is a rising indication for LT, especially for Hispanic males, due to the increasing prevalence of ALD and NASH in the United States.

Keywords

NAFLD - NASH - liver transplant

Supporting Information

None.


 

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