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Liver Transplantation for Nonalcoholic Steatohepatitis: The New Epidemic

Agopian, Vatche G. MD*; Kaldas, Fady M. MD*; Hong, Johnny C. MD*; Whittaker, Meredith BS*; Holt, Curtis PharmD*; Rana, Abbas MD*; Zarrinpar, Ali MD, PhD*; Petrowsky, Henrik MD*; Farmer, Douglas MD*; Yersiz, Hasan MD*; Xia, Victor MD; Hiatt, Jonathan R. MD*; Busuttil, Ronald W. MD, PhD*

doi: 10.1097/SLA.0b013e31826b4b7e
Papers of the 132nd ASA Annual Meeting

Objective: To analyze incidence, outcomes, and utilization of health care resources in liver transplantation (LT) for nonalcoholic steatohepatitis (NASH).

Summary of Background Data: With the epidemic of obesity and metabolic syndrome in nearly 33% of the US population, NASH is projected to become the leading indication for LT in the next several years. Data on predictors of outcome and utilization of health care resources after LT in NASH is limited.

Methods: We conducted an analysis from our prospective database of 144 adult NASH patients who underwent LT between December 1993 and August 2011. Outcomes and resource utilization were compared with other common indications for LT. Independent predictors of graft and patient survival were identified.

Results: The average Model for End-Stage Liver Disease score was 33. The frequency of NASH as the primary indication for LT increased from 3% in 2002 to 19% in 2011 to become the second most common indication for LT at our center behind hepatitis C. NASH patients had significantly longer operative times (402 vs 322 minutes; P < 0.001), operative blood loss (18 vs 14 packed red blood cell units; P = 0.001), and posttransplant length of stay (35 vs 29 days; P = 0.032), but 1-, 3-, and 5-year graft (81%, 71%, 63%) and patient (84%, 75%, 70%) survival were comparable with other diagnoses. Age greater than 55 years, pretransplant intubation, dialysis, hospitalization, presence of hepatocellular carcinoma on explant, donor age greater than 55 years, and cold ischemia time greater than 550 minutes were significant independent predictors of survival for all patients, whereas body mass index greater than 35 was a predictor in NASH patients only.

Conclusions: We report the largest single institution experience of LT for NASH. Over a 10-year period, the frequency of LT for NASH has increased 5-fold. Although outcomes are comparable with LT for other indications, health care resources are stressed significantly by this new and increasing group of transplant candidates.

An analysis of incidence, outcomes, and health care resource utilizations for 144 patients who underwent liver transplantation for nonalcoholic steatohepatitis (NASH) was performed. Although the frequency of NASH as an indication for liver transplantation increased 5-fold over 10 years, graft and patient survival were comparable with other diagnoses.

*Dumont-UCLA Transplant and Liver Cancer Centers, Pfleger Liver Institute, Department of Surgery, Los Angeles, CA

Department of Anesthesiology, David Geffen School of Medicine at University of California, Los Angeles, CA.

Reprints: Ronald W. Busuttil, MD, PhD, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, 10833 Le Conte Avenue, Room 77-120 CHS, Box 957054, Los Angeles, CA 90095. E-mail:

Disclosure: The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.