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Liver Transplantation for Nonalcoholic Steatohepatitis (NASH): The New Epidemic
Vatche G Agopian*, Fady M Kaldas*, Johnny Hong*, Meredith Whittaker*, Abbas Rana*, Ali Zarrinpar*, Henrik Petrowsky*, Curtis Holt*, Douglas G Farmer, Hasan Yersiz*, Jonathan R Hiatt, Ronald W Busuttil
University of California, Los Angeles, Los Angeles, CA

Objective: To analyze incidence, outcome, and impact on healthcare resources of liver transplantation (LT) for nonalcoholic steatohepatitis (NASH). With the epidemic of obesity and metabolic syndrome in nearly 33% of the US population, NASH is projected to become the leading indication for LT in the next several years.
Methods: Analysis from our prospective database was performed. Outcomes and resource utilization were compared to other indications for LT.
Results: 144 patients underwent LT for NASH, with 136 between 2002-2011. The average MELD was 33. The frequency of NASH as the primary indication for LT increased from 3% in 2002 to 19% in 2011 to become the second most common indication for LT at our center. NASH patients had significantly longer operative times (6.9 vs 5.3 hours; P<0.001), operative blood loss (18 vs 14 uPRBC; P=0.004) and total length of stay (35 vs 29 days; P=0.046), but 1 and 3 year graft (80%, 70%) and patient (84%, 75%) survival were comparable to other groups (Table 1).
Conclusions: We report the largest single institution experience of LT for NASH. Over a 9-year period, the frequency of NASH as the primary indication for LT has increased fivefold and continues to rise. Although outcomes are comparable to LT for other indications, the donor pool and healthcare resources are stressed significantly by this new and increasing group of transplant candidates.
Table 1
*P<0.05 vs NASHNASH (n=144)HCV (n=691)HBV (n=127)Alcohol (n=185)Cryptogenic (n=58)PBC/PSC (n=89)
Average MELD3328*28*333230*
BMI > 30 (%)5935*17*34*29*19*
Diabetes (%)5724*30*32*33*9*
Operative blood loss (uPRBC)1814*14*1714*11*
OR time (min)412315*308*330*315*317*
Length of Stay (d)3527*23*363636
Explant HCC (%)2551*67*282210
3-yr graft survival (%)7057*69697170
3-yr patient survival (%)7562*71737376

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