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Kwong AJ, Devuni D, Wang C, Boike J, Jo J, VanWagner L, Serper M, Jones L, Sharma R, Verna EC, Shor J, German MN, Hristov A, Lee A, Spengler E, Koteish AA, Sehmbey G, Seetharam A, John N, Patel Y, Kappus MR, Couri T, Paul S, Salgia RJ, Nhu Q, Frenette CT, Lai JC, Goel A. Outcomes of Liver Transplantation Among Older Recipients With Nonalcoholic Steatohepatitis in a Large Multicenter US Cohort: the Re-Evaluating Age Limits in Transplantation Consortium. Liver Transpl 2020; 26:1492-1503. [PMID: 33047893 PMCID: PMC7960487 DOI: 10.1002/lt.25863] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/20/2020] [Accepted: 06/14/2020] [Indexed: 12/11/2022]
Abstract
The liver transplantation (LT) population is aging, with the need for transplant being driven by the growing prevalence of nonalcoholic steatohepatitis (NASH). Older LT recipients with NASH may be at an increased risk for adverse outcomes after LT. Our objective is to characterize outcomes in these recipients in a large multicenter cohort. All primary LT recipients ≥65 years from 2010 to 2016 at 13 centers in the Re-Evaluating Age Limits in Transplantation (REALT) consortium were included. Of 1023 LT recipients, 226 (22.1%) were over 70 years old, and 207 (20.2%) had NASH. Compared with other LT recipients, NASH recipients were older (68.0 versus 67.3 years), more likely to be female (47.3% versus 32.8%), White (78.3% versus 68.0%), Hispanic (12.1% versus 9.2%), and had higher Model for End-Stage Liver Disease-sodium (21 versus 18) at LT (P < 0.05 for all). Specific cardiac risk factors including diabetes with or without chronic complications (69.6%), hypertension (66.3%), hyperlipidemia (46.3%), coronary artery disease (36.7%), and moderate-to-severe renal disease (44.4%) were highly prevalent among NASH LT recipients. Graft survival among NASH patients was 90.3% at 1 year and 82.4% at 3 years compared with 88.9% at 1 year and 80.4% at 3 years for non-NASH patients (log-rank P = 0.58 and P = 0.59, respectively). Within 1 year after LT, the incidence of graft rejection (17.4%), biliary strictures (20.9%), and solid organ cancers (4.9%) were comparable. Rates of cardiovascular (CV) complications, renal failure, and infection were also similar in both groups. We observed similar posttransplant morbidity and mortality outcomes for NASH and non-NASH LT recipients. Certain CV risk factors were more prevalent in this population, although posttransplant outcomes within 1 year including CV events and renal failure were similar to non-NASH LT recipients.
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Affiliation(s)
- Allison J. Kwong
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Palo Alto, CA
| | - Deepika Devuni
- University of Massachusetts Medical Center, Worcester, MA
| | - Connie Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Justin Boike
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL
| | - Jennifer Jo
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL
| | - Lisa VanWagner
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL
| | - Marina Serper
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lauren Jones
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rajani Sharma
- Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, NY
| | - Elizabeth C. Verna
- Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, NY
| | - Julia Shor
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Margarita N. German
- Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Alexander Hristov
- Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Alexander Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Erin Spengler
- Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | | | - Gurbir Sehmbey
- Transplant Hepatology, Banner University Medical Center, Phoenix, AZ
| | - Anil Seetharam
- Transplant Hepatology, Banner University Medical Center, Phoenix, AZ
| | - Nimy John
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Palo Alto, CA
| | - Yuval Patel
- Division of Gastroenterology, Department of Medicine, School of Medicine, Duke University, Durham, NC
| | - Matthew R. Kappus
- Division of Gastroenterology, Department of Medicine, School of Medicine, Duke University, Durham, NC
| | - Thomas Couri
- Center for Liver Diseases, University of Chicago, Chicago, IL
| | - Sonali Paul
- Center for Liver Diseases, University of Chicago, Chicago, IL
| | - Reena J. Salgia
- Division of Gastroenterology, Department of Medicine, Henry Ford, Detroit, MI
| | | | | | | | - Aparna Goel
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Palo Alto, CA
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