| Abstract: | BACKGROUND AND AIMS: NASH is the leading indication for liver transplant (LT) in women and the elderly. Granular detail into factors impacting survival in this population are needed to optimize management and improve outcomes. METHODS: Patients receiving LT for NASH cirrhosis from 1997 to 2017 across 7 transplant centers (NailNASH consortium) were analyzed. The primary outcome was all-cause mortality and causes of death were enumerated. All outcomes were cross referenced with UNOS and adjudicated at each individual center. Cox Regression models were constructed to elucidate clinical factors impacting mortality. RESULTS: 938 patients with a median follow up of 3.8 yrs (IQR, 1.60-7.05 yrs), were included. The 1-, 3-, 5-,10- and 15-year survival of the cohort was 93%, 88%, 83%, 69%, 46%, respectively. Of 195 deaths in the cohort, the most common causes were infection (19%), cardiovascular disease (18%), cancer (17%) and liver related (11%). Inferior survival was noted in patients >65 years. On multivariable analysis, age >65 [HR 1.70; 95% CI 1.04-2.77, P=0.04], ESRD (HR 1.55: 95% CI 1.04-2.31, P=0.03), African American race (HR 5.25: 95% CI 2.12-12.96; P=0.0003) and non-CNI based regimens (HR 2.05: 95% CI 1.19-3.51, P=0.009) were associated with increased mortality. Statin use post-LT favorably impacted survival (HR 0.38: 95% CI 0.19-0.75; P=0.005). CONCLUSION: Despite excellent long-term survival, patients transplanted for NASH at >65 years or with type 2 DM at transplant had higher mortality. Statin use post-transplant attenuated risk and was associated with improved survival across all subgroups suggesting that careful patient selection and implementation of protocol-based management of metabolic co-morbidities may further improve clinical outcomes. |
