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High incidence of hepatocellular carcinoma and postoperative complications in patients with nonalcoholic steatohepatitis as a primary indication for deceased liver transplantation

Kern, Barbaraa,g; Feurstein, Benedikta; Fritz, Josefb; Fabritius, Corneliaa; Sucher, Roberth; Graziadei, Ivof; Bale, Retoc; Tilg, Herbertd; Zoller, Heinzd; Newsome, Philipi; Eschertzhuber, Stephane; Margreiter, Raimunda; Öfner, Dietmara; Schneeberger, Stefana

European Journal of Gastroenterology & Hepatology: February 2019 - Volume 31 - Issue 2 - p 205–210
doi: 10.1097/MEG.0000000000001270
Original Articles: Hepatology

Background and aims Nonalcoholic steatohepatitis (NASH) is an increasingly prevalent indication for liver transplantation (LT) across the world. The relative outcomes following transplantation are poorly described in this cohort. We aimed to analyze the incidence and outcome of LT for NASH as compared with other indications.

Patients and methods This is a retrospective analysis of 513 patients who underwent deceased-donor, adult LT between 2002 and 2012 as recorded at the Medical University of Innsbruck, Austria.

Results The prevalence of NASH cirrhosis as indication for liver transplantation was 12.7% (65/513). Patient survival in patients with NASH was comparable to other indications, including alcohol-induced liver steatosis (ALD) and hepatitis C virus (HCV) (P=0.208). Patients with NASH were older, had a higher model of end-stage liver disease score and a higher BMI, but patient survival and graft survival were equivalent to other indications. Patients with hepatocellular carcinoma (HCC) as primary indication for liver transplantation showed significantly inferior overall survival as compared with the other indications (P=0.003). Patients with NASH had coexisting HCC in 53.7% of cases, whereas HCC in ALD, HCV and other indications was prevalent in 31.2, 47.7, and 34.5%, respectively (P<0.0001). Patients with NASH had a higher incidence of advanced HCCs (outside the Milan criteria) than patients with ALD, HCV, and other indications (P=0.034). Postoperative complications were significantly higher in the NASH cohort (P=0.048).

Conclusion In this single-center LT database analysis, patients with NASH have a higher incidence and a more rapid progression of HCC as well as an increased incidence of postoperative complications. Our findings warrant confirmation by others.

Departments of aVisceral, Transplantation and Thoracic Surgery

bMedical Statistics, Informatics and Health Economics

cRadiology and Microinvasive Therapy

dInternal Medicine I, Gastroenterology, Hepatology and Endocrinology

eAnaestesia and Intensive Care Medicine, Medical University Innsbruck, Innsbruck

fDepartment of Internal Medicine, Academic Teaching Hospital, Hall in Tirol, Austria

gDepartment of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité – Universitaetsmedizin Berlin, Berlin

hDepartment of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leibzig, Leibzig, Germany

iNational Institute for Health Research Birmingham Biomedical Research Centre and Centre for Liver & Gastroenterology Research, University of Birmingham, Birmingham, UK

Correspondence to Barbara Kern, MD, PhD, Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria Tel: +43 512 504 22601; fax: +43 512 504 22605; e-mail:

Received May 29, 2018

Accepted August 31, 2018

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