Poor Survival after Retransplantation in NASH Cirrhosis

Avesh J. Thuluvath, Po-Hung Chen, Paul J. Thuluvath, Sergey Kantsevoy, Yulia Savva

Research output: Contribution to journalArticle

Abstract

Background Nonalcoholic steatohepatitis (NASH) cirrhosis is a common indication for liver transplantation (LT) in the United States. There is a paucity of data on retransplantation (re-LT) in those who were initially transplanted for NASH. Methods We queried the United Network for Organ Sharing data sets from 2002 to 2016 to analyze the outcomes of adults with NASH (n = 128) and compared them with groups that received re-LT for cryptogenic cirrhosis (n = 189), alcoholic cirrhosis (n = 300) or autoimmune hepatitis cirrhosis (n = 118) after excluding multiple-organ re-LT and individuals with hepatocellular carcinoma. 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 the first and the second 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 with 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 (hazard ratio [HR], 1.64; 1.19-2.26), Donor Risk Index (HR, 1.51; 1.08-2.12), and a high Model for End-stage Liver Disease 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.

Original languageEnglish (US)
Pages (from-to)101-108
Number of pages8
JournalTransplantation
Volume103
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Fibrosis
Survival
Liver Transplantation
Transplants
Alcoholic Liver Cirrhosis
Autoimmune Hepatitis
End Stage Liver Disease
Portal Vein
Non-alcoholic Fatty Liver Disease
Type 2 Diabetes Mellitus
Renal Insufficiency
Hepatocellular Carcinoma
Thrombosis
Survival Rate
Obesity
Demography
Tissue Donors
Mortality

ASJC Scopus subject areas

  • Transplantation

Cite this

Thuluvath, A. J., Chen, P-H., Thuluvath, P. J., Kantsevoy, S., & Savva, Y. (2019). Poor Survival after Retransplantation in NASH Cirrhosis. Transplantation, 103(1), 101-108. https://doi.org/10.1097/TP.0000000000002135

Poor Survival after Retransplantation in NASH Cirrhosis. / Thuluvath, Avesh J.; Chen, Po-Hung; Thuluvath, Paul J.; Kantsevoy, Sergey; Savva, Yulia.

In: Transplantation, Vol. 103, No. 1, 01.01.2019, p. 101-108.

Research output: Contribution to journalArticle

Thuluvath, AJ, Chen, P-H, Thuluvath, PJ, Kantsevoy, S & Savva, Y 2019, 'Poor Survival after Retransplantation in NASH Cirrhosis', Transplantation, vol. 103, no. 1, pp. 101-108. https://doi.org/10.1097/TP.0000000000002135
Thuluvath, Avesh J. ; Chen, Po-Hung ; Thuluvath, Paul J. ; Kantsevoy, Sergey ; Savva, Yulia. / Poor Survival after Retransplantation in NASH Cirrhosis. In: Transplantation. 2019 ; Vol. 103, No. 1. pp. 101-108.
@article{ae40ac604df7411e9f1cf5ee6a810e79,
title = "Poor Survival after Retransplantation in NASH Cirrhosis",
abstract = "Background Nonalcoholic steatohepatitis (NASH) cirrhosis is a common indication for liver transplantation (LT) in the United States. There is a paucity of data on retransplantation (re-LT) in those who were initially transplanted for NASH. Methods We queried the United Network for Organ Sharing data sets from 2002 to 2016 to analyze the outcomes of adults with NASH (n = 128) and compared them with groups that received re-LT for cryptogenic cirrhosis (n = 189), alcoholic cirrhosis (n = 300) or autoimmune hepatitis cirrhosis (n = 118) after excluding multiple-organ re-LT and individuals with hepatocellular carcinoma. 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 the first and the second 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 with 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 (hazard ratio [HR], 1.64; 1.19-2.26), Donor Risk Index (HR, 1.51; 1.08-2.12), and a high Model for End-stage Liver Disease 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.",
author = "Thuluvath, {Avesh J.} and Po-Hung Chen and Thuluvath, {Paul J.} and Sergey Kantsevoy and Yulia Savva",
year = "2019",
month = "1",
day = "1",
doi = "10.1097/TP.0000000000002135",
language = "English (US)",
volume = "103",
pages = "101--108",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Poor Survival after Retransplantation in NASH Cirrhosis

AU - Thuluvath, Avesh J.

AU - Chen, Po-Hung

AU - Thuluvath, Paul J.

AU - Kantsevoy, Sergey

AU - Savva, Yulia

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background Nonalcoholic steatohepatitis (NASH) cirrhosis is a common indication for liver transplantation (LT) in the United States. There is a paucity of data on retransplantation (re-LT) in those who were initially transplanted for NASH. Methods We queried the United Network for Organ Sharing data sets from 2002 to 2016 to analyze the outcomes of adults with NASH (n = 128) and compared them with groups that received re-LT for cryptogenic cirrhosis (n = 189), alcoholic cirrhosis (n = 300) or autoimmune hepatitis cirrhosis (n = 118) after excluding multiple-organ re-LT and individuals with hepatocellular carcinoma. 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 the first and the second 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 with 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 (hazard ratio [HR], 1.64; 1.19-2.26), Donor Risk Index (HR, 1.51; 1.08-2.12), and a high Model for End-stage Liver Disease 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.

AB - Background Nonalcoholic steatohepatitis (NASH) cirrhosis is a common indication for liver transplantation (LT) in the United States. There is a paucity of data on retransplantation (re-LT) in those who were initially transplanted for NASH. Methods We queried the United Network for Organ Sharing data sets from 2002 to 2016 to analyze the outcomes of adults with NASH (n = 128) and compared them with groups that received re-LT for cryptogenic cirrhosis (n = 189), alcoholic cirrhosis (n = 300) or autoimmune hepatitis cirrhosis (n = 118) after excluding multiple-organ re-LT and individuals with hepatocellular carcinoma. 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 the first and the second 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 with 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 (hazard ratio [HR], 1.64; 1.19-2.26), Donor Risk Index (HR, 1.51; 1.08-2.12), and a high Model for End-stage Liver Disease 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.

UR - http://www.scopus.com/inward/record.url?scp=85059198240&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059198240&partnerID=8YFLogxK

U2 - 10.1097/TP.0000000000002135

DO - 10.1097/TP.0000000000002135

M3 - Article

C2 - 29470354

AN - SCOPUS:85059198240

VL - 103

SP - 101

EP - 108

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 1

ER -