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Poor Survival After Retransplantation in NASH Cirrhosis

Thuluvath, Avesh J., MD1; Chen, Po-Hung, MD1; Thuluvath, Paul J., MD, FRCP2,3; Kantsevoy, Sergey, MD, PhD2,3; Savva, Yulia, PhD2

doi: 10.1097/TP.0000000000002135
Original Clinical Science—Liver

Background Nonalcoholic steatohepatitis (NASH) cirrhosis is a common indication for liver transplantation (LT) in the United States. There is a paucity of data on retransplantation (re-LT) in those who were initially transplanted for NASH.

Methods We queried the United Network for Organ Sharing data sets from 2002 to 2016 to analyze the outcomes of adults with NASH (n = 128) and compared them with groups that received re-LT for cryptogenic cirrhosis (n = 189), alcoholic cirrhosis (n = 300) or autoimmune hepatitis cirrhosis (n = 118) after excluding multiple-organ re-LT and individuals with hepatocellular carcinoma. We estimated survival probabilities using a Kaplan-Meier estimator, and a relative risk of patient and graft mortality using proportional hazards regression.

Results The NASH group was older and had a higher prevalence of obesity, type II diabetes mellitus, renal insufficiency, portal vein thrombosis, and poor performance status. The median interval between the first and the second LT was shorter in the NASH group (27 days). The graft and patient 5-year survival rates were lower for the NASH group after re-LT compared with the other 3 groups. After adjusting for demographic and disease complication factors, the factors that increased a risk of patient or graft failure were a poor performance status (hazard ratio [HR], 1.64; 1.19-2.26), Donor Risk Index (HR, 1.51; 1.08-2.12), and a high Model for End-stage Liver Disease score (HR, 1.02; 1.00-1.04).

Conclusions Despite the comparable outcomes reported for initial LT among the various etiologies, the outcome of re-LT is significantly worse for NASH cirrhosis.

1 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

2 The Institute of Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, MD.

3 Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.

Received 14 November 2017. Revision received 13 January 2018.

Accepted 26 January 2018.

The authors declare no funding or conflicts of interest.

A.J.T. contributed to the idea. Y.S. did the statistical analysis. A.J.T., Y.S., and P.J.T. reviewed the data. A.J.T., P.H.H., S.K., Y.S., and P.J.T. wrote the article. All the authors reviewed the final article.

Correspondence: Avesh J. Thuluvath, MD, Department of Medicine, Johns Hopkins University School of Medicine, 4940, Eastern Ave, Baltimore, MD 21224. (

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