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Liver Transplantation in Cryptogenic Cirrhosis: Outcome Comparisons Between NASH, Alcoholic, and AIH Cirrhosis

Thuluvath, Paul, Joseph, MD, FRCP1,2; Hanish, Steven, MD2; Savva, Yulia, PhD1

doi: 10.1097/TP.0000000000002030
Original Clinical Science—Liver

Background The outcomes of liver transplantation (LT) in patients with cryptogenic cirrhosis (CC) have not been adequately examined except for small case series. We believe that patients currently listed as CC have truly cryptogenic liver disease and may have different post-LT outcomes compared with nonalcoholic steatohepatitis (NASH).

Methods We compared the post-LT outcomes of adults with CC (n = 3241) and compared them with cirrhosis from NASH (n = 4089), alcoholic cirrhosis (AC) (n = 7837), and autoimmune hepatitis (AIH) (n = 1435) using the United Network for Organ Sharing database from 2002 to 2016. We excluded those who had multiorgan transplantation and hepatocellular carcinoma. In addition to the well-known predictors of liver transplant outcomes, we analyzed the impact of Karnofsky Performance Status score at LT on immediate and late outcomes.

Results There were significant differences in clinical characteristics between the groups. Despite these differences in clinical characteristics and risk factors, CC had similar graft and patient survival to NASH, AC, and AIH when assessed by Kaplan-Meier survival. Multivariate Cox regression analysis showed that graft and patient survival was similar in all 4 groups after adjusting for other confounders. Hispanics had a 24% lower risk of death (hazard ratio, 0.76) compared with whites in these combined cohorts after adjusting for all risk factors. In addition to other known risk factors, Karnofsky Performance Status score of 30% or less was associated with a 33% increase in risk of death (hazard ratio, 1.33) on multivariate analysis.

Conclusion Patients with CC had similar graft and patient survival when compared with NASH, AC, and AIH cirrhosis.

Using the UNOS database, the authors report on baseline features and outcome of patients undergoing liver transplantation between 2002 and 2016 for cryptogenic cirrhosis, nonalcoholic steatohepatitis, alcohol-liver disease and autoimmune hepatitis.

1 Institute of Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD.

2 Departments of Surgery and Medicine, University of Maryland School of Medicine, Baltimore, MD.

Received 25 July 2017. Revision received 27 September 2017.

Accepted 12 October 2017.

The authors declare no funding or conflicts of interest.

P.J.T. and S.H. contributed to the idea. Y.S. did the statistical analysis. P.J.T. wrote the article. S.H. and Y.S. reviewed the final article.

Correspondence: Paul J. Thuluvath, MD, FAASLD, FRCP, Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD 21202. (thuluvath@gmail.com).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

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