AASLD-Health of Recipients and Quality of Donor are Greater Factors in Survival than Metabolic Factors

Health of Recipients and Quality of Donor are Greater Factors in Survival than Metabolic Factors

Nonalcoholic steatohepatitis (NASH) is growing in incidence in the United States. It is also growing as an indication for liver transplantation. Researchers from the University of California
– San Francisco concluded in their study that patients with or suspected of having NASH have poorer survival rates than patients who have neither NASH nor hepatitis C virus (HCV). According to Danielle Brandman, MD, MAS, "In 20-30 years, NASH will likely be one of the leading indications for liver transplantation. To ensure the best outcome with liver transplantation in this patient population, continued efforts to identify the key recipient and donor factors influencing long-term survival are critical."

Authors of this study, which will be presented at the annual meeting of the American Association for the Study of Liver Diseases (Sunday, November 6), retrospectively examined the database of Organ Procurement and Transplant Network (OPTN) of the United Network of Organ Sharing (UNOS). Of the 30,182 records of liver transplantation recipients, 10 percent of the patients either had NASH or probable NASH.

The records were also examined for age, gender, race, as well as factors associated with NASH: obesity or higher BMI, pretransplantation diabetes mellitus, hypertension, and receipt of dialysis prior to transplantation. MELD score at the time of transplantation and level of donor risk were examined as independent predictors of mortality.

Patients with NASH or probable NASH have worse survival rates than patients without NASH or hepatitis C but this survival difference was largely related to differences in recipient severity of liver disease and donor quality and not by differences in the frequency of metabolic complications, such as diabetes mellitus, obesity or need for dialysis prior to transplantation.
"Our findings that pre-transplant metabolic factors are not the most important factors determining survival after transplant may be related to how centers assess severity and risk of metabolic complications," said Dr. Brandman. "An improved understanding of how candidates are evaluated and determined to be candidates for transplantation is important. Moreover, while our study focused on the presence or absence of metabolic factors as predictors of post-transplant outcomes, additional studies to characterize the severity of the metabolic comorbidities pre-transplant and how this affects survival are needed."

When asked to address the potential impact on patient care, Dr. Brandman replied, "The study highlights the factors affecting survival among transplant recipients with NASH. We show that survival is mostly strongly influenced by the patient's severity of liver disease and donor factors. This implies that early referral and listing for transplantation and careful selection of donors of higher quality are potential means of maximizing rates of survival."
Abstract title:Temporal trends in liver transplantation (LT) for nonalcoholic steatohepatitis (NASH)

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AASLD is the leading medical organization for advancing the science and practice of hepatology. Founded by physicians in 1950, AASLD's vision is to prevent and cure liver diseases. This year's Liver Meeting®, held in San Francisco, California, November 4 – 8, will bring together more than 8,000 researchers from 55 countries.
A press room will be available from November 5 at the annual meeting. For copies of abstracts and press releases, or to arrange researcher interviews, contact Gregory Bologna at 703-299-9766.

Press releases and all abstracts are available online at www.aasld.org.