Y. Liang1, D. Desai1, P. Vagefi1, C. Hwang1, M. MacConmara1 2UT Southwestern Medical Center,Medicine,Dallas, TX, USA 1UT Southwestern Medical Center,Surgery,Dallas, TX, USA
Introduction:
Non-alcoholic steatohepatitis (NASH) will likely become the most common indication for liver transplantation during the next decade. We sought to determine the impact of recipient and donor selection practices on outcomes in NASH recipients.
Methods:
The United Network for Organ Sharing database was queried to identify all liver transplant recipients from 2000 to 2017. Pediatric recipients (< 18 years) were excluded from the analysis. Donor and recipient demographic, clinical and biochemical data were extracted and risk factors for outcome after transplant were compared between NASH and all other cause recipients. Patient and graft survival rates were calculated for both groups. Categorical differences were compared using the unpaired Student's t-test and nominal variables using either the Chi Square test. A p-value of <0.01 was considered significant.
Results:
88,602 adult liver transplants were completed of which NASH recipients accounted for 9,689 transplants. NASH recipients were older (58.7 vs. 53.2 years, p<0.001) with higher MELD scores (23.5 vs. 22.1, p<0.001). Donor age >60 years (17.1% vs. 12.9% p<0.001), donor macrosteatosis over 30% (3.2% vs. 2.1%, p<0.001) and donor donation after cardiac death (DCD) status (5.8% vs. 4.5% p<0.001) were all significantly higher in NASH recipients. Cold ischemia time (6.5 vs. 6.9 hours, p<0.001) was shorter for NASH recipients. Interestingly, graft survival was significantly better for NASH recipients (Figure 1, p<0.001).
Conclusion:
NASH recipients have superior outcomes following liver transplantation despite utilization of higher risk donor livers and should be considered for offers of marginal organs.
