Outcomes of Liver Transplantation for Non-alcoholic Steatohepatitis: a European Liver Transplant Registry Study

Abstract Background & Aims Little is known about outcomes of liver transplantation for patients with non-alcoholic steatohepatitis (NASH). We aimed to determine the frequency and outcomes of liver transplantation for patients with NASH in Europe and identify prognostic factors. Methods We analyzed data from patients transplanted for end-stage liver disease between January 2002 and December 2016 using the European Liver Transplant Registry database. We compared data between patients with NASH versus other etiologies. The principle endpoints were patient and overall allograft survival. Results Among 68,950 adults undergoing first liver transplantation, 4.0% were transplanted for NASH – an increase from 1.2% in 2002 to 8.4% in 2016. A greater proportion of patients transplanted for NASH (39.1%) had hepatocellular carcinoma (HCC) than non-NASH patients (28.9%, P P =.713) or grafts (HR 0.99; P =.815) after accounting for available recipient and donor variables. Infection (24.0%) and cardio/cerebrovascular complications (5.3%) were the commonest causes of death in NASH patients without HCC. Increasing recipient age (61-65 years: HR 2.07, P 65: HR 1.72, P =.017), elevated MELD (>23: HR 1.48, P =.048) and low ( -2 : HR 4.29, P =.048) or high (>40kg.m -2 : HR 1.96, P =.012) recipient BMI independently predicted death in patients transplanted for NASH without HCC. Data must be interpreted in the context of absent recognised confounders, such as pre-morbid metabolic risk factors. Conclusions The number and proportion of liver transplants performed for NASH in Europe has increased from 2002 through 2016. HCC was more common in patients transplanted with NASH. Survival of patients and grafts in patients with NASH is comparable to that of other disease indications. Lay Summary NASH is a growing indication for liver transplantation in Europe, with good overall outcomes, although careful assessment for risk factors is required to maintain favorable post-transplant outcomes.