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Transplant Outcomes in Older Patients With Nonalcoholic Steatohepatitis Compared to Alcohol-related Liver Disease and Hepatitis C.

Publication ,  Journal Article
Henson, JB; Wilder, JM; Kappus, MR; Barbas, AS; Moylan, CA; Niedzwiecki, D; Muir, AJ; Berg, CL; Patel, YA
Published in: Transplantation
June 2020

BACKGROUND: Patients with nonalcoholic steatohepatitis (NASH) are waitlisted at older ages than individuals with other liver diseases, but the effect of age on liver transplantation (LT) outcomes in this population and whether it differs from other etiologies is not known. We aimed to evaluate the impact of age on LT outcomes in NASH. METHODS: The United Network for Organ Sharing database was used to identify adults with NASH, hepatitis C virus (HCV) infection, and alcohol-related liver disease (ALD) listed for LT during 2004-2017. Patients were split into age groups (18-49, 50-54, 55-59, 60-64, 65-69, ≥70), and their outcomes were compared. RESULTS: From 2004 to 2017, 14 197 adults with NASH were waitlisted, and the proportion ≥65 increased from 15.8% to 28.9%. NASH patients ages 65-69 had an increased risk of waitlist and posttransplant mortality compared to younger groups, whereas the outcomes in ages 60-64 and 55-59 were similar. The outcomes of individuals with NASH were similar to patients of the same age group with ALD or HCV. Functional status and dialysis were predictors of posttransplant mortality in individuals ≥65 with NASH, and cardiovascular disease was the leading cause of death. CONCLUSIONS: Older NASH patients (≥65) have an increased risk of waitlist and posttransplant mortality compared to younger individuals, although outcomes were similar to patients with ALD or HCV of corresponding age. These individuals should be carefully evaluated prior to LT, considering their functional status, renal function, and cardiovascular risk. Further studies are needed to optimize outcomes in this growing population of transplant candidates.

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Published In

Transplantation

DOI

EISSN

1534-6080

Publication Date

June 2020

Volume

104

Issue

6

Start / End Page

e164 / e173

Location

United States

Related Subject Headings

  • Young Adult
  • Waiting Lists
  • United States
  • Surgery
  • Postoperative Period
  • Patient Selection
  • Non-alcoholic Fatty Liver Disease
  • Middle Aged
  • Male
  • Liver Transplantation
 

Citation

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Chicago
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Henson, J. B., Wilder, J. M., Kappus, M. R., Barbas, A. S., Moylan, C. A., Niedzwiecki, D., … Patel, Y. A. (2020). Transplant Outcomes in Older Patients With Nonalcoholic Steatohepatitis Compared to Alcohol-related Liver Disease and Hepatitis C. Transplantation, 104(6), e164–e173. https://doi.org/10.1097/TP.0000000000003219
Henson, Jacqueline B., Julius M. Wilder, Matthew R. Kappus, Andrew S. Barbas, Cynthia A. Moylan, Donna Niedzwiecki, Andrew J. Muir, Carl L. Berg, and Yuval A. Patel. “Transplant Outcomes in Older Patients With Nonalcoholic Steatohepatitis Compared to Alcohol-related Liver Disease and Hepatitis C.Transplantation 104, no. 6 (June 2020): e164–73. https://doi.org/10.1097/TP.0000000000003219.
Henson JB, Wilder JM, Kappus MR, Barbas AS, Moylan CA, Niedzwiecki D, et al. Transplant Outcomes in Older Patients With Nonalcoholic Steatohepatitis Compared to Alcohol-related Liver Disease and Hepatitis C. Transplantation. 2020 Jun;104(6):e164–73.
Henson, Jacqueline B., et al. “Transplant Outcomes in Older Patients With Nonalcoholic Steatohepatitis Compared to Alcohol-related Liver Disease and Hepatitis C.Transplantation, vol. 104, no. 6, June 2020, pp. e164–73. Pubmed, doi:10.1097/TP.0000000000003219.
Henson JB, Wilder JM, Kappus MR, Barbas AS, Moylan CA, Niedzwiecki D, Muir AJ, Berg CL, Patel YA. Transplant Outcomes in Older Patients With Nonalcoholic Steatohepatitis Compared to Alcohol-related Liver Disease and Hepatitis C. Transplantation. 2020 Jun;104(6):e164–e173.

Published In

Transplantation

DOI

EISSN

1534-6080

Publication Date

June 2020

Volume

104

Issue

6

Start / End Page

e164 / e173

Location

United States

Related Subject Headings

  • Young Adult
  • Waiting Lists
  • United States
  • Surgery
  • Postoperative Period
  • Patient Selection
  • Non-alcoholic Fatty Liver Disease
  • Middle Aged
  • Male
  • Liver Transplantation