Increased Risk of Death in First Year After Liver Transplantation Among Patients with Nonalcoholic Steatohepatitis vs Liver Disease of Other Etiologies

Background & Aims An increasing number of patients with non-alcoholic steatohepatitis (NASH) require liver transplantation. We compared outcomes of patients with liver diseases of different etiologies (NASH, hepatitis C virus [HCV]-associated liver disease, and alcohol-associated liver disease [ALD]). Methods We analyzed data from the United Network for Organ Sharing registry on 6344 patients who underwent liver transplantation for NASH, 17,037 for cirrhosis from chronic HCV infection, and 9279 for ALD. We collected data from patients who underwent liver transplantation during the following time periods: 2008–2010, 2011–2013, 2014–2015, 2016–2017. We compared outcomes of different groups using Cox regression models, adjusting for donor and recipient characteristics. Results For patients who underwent liver transplantation during 2016–2017, a significantly lower proportion of patients with NASH survived for 1 year after transplantation than patients with HCV ( P  = .004) or ALD ( P P  = .03), regardless of the presence of hepatocellular carcinoma. The effects of increasing age were greatest among patients with NASH: compared to patients younger than 50 years, hazard ratios for overall mortality were 1.31 for patients 50–59 years ( P  = .02), 1.66 for patients 60–64 years ( P P P P Conclusions In an analysis of data from patients who underwent liver transplantation during 2016–2017, we found the risk of death within 1 year after transplant was higher among patients with NASH than HCV-associated liver disease or ALD. Risk of death increased with age, and patients with NASH have a higher risk of death from cardiovascular or cerebrovascular disease.