Liver transplantation and non-alcoholic fatty liver disease

Table 1 Nonalcoholic steatohepatitis related cirrhosis as an indication for liver tranplantation

Ref.	Database	Years	NASH Cirrhosis Tx	NASH Cirrhosis waiting list
Charlton et al[9]	SRTR	2001-2009	Increased
			1.2%→9.7%
Kemmer et al[10]	UNOS	2007-2010	Increased
			5.1%→7.5%
http://optn.transplant.hrsa.gov	OTPN	2013 Nov 1st		8.5% + 5.5% for CC

NASH: Nonalcoholic steatohepatitis; CC: Cryptogenic cirrhosis; Tx: Transplantation; SRTR: Scientific registry of transplant recipients, United States; UNOS: United network for organ sharing, United States; OTPN: Organ procurement and transplantation network, United States.

Table 2 Post liver transplantation outcomes for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis

Ref.	NASH	Non-NASH	Remarks
	Post-LT mortality
Malik et al[26]
24 h	4.0%	1%-3%	Non-NASH: PBC, PSC, ALD, HCV
30-d	6.0%	2%-5%	NASH group: Increased early mortality
1-yr	21.5%	13%-18%	Infection: Main cause of death in NASH group (50%)
3-yr	25.5%	16%-30%	High risk NASH group: 50% 1-yr mortality
5-yr	27.5%	19%-35%	Older age (> 60 yr), Higher BMI (> 30 kg/m2), Pre-LT diabetes mellitus and Hypertension
	Post-LT survival
Bhagat el al[27]
1-yr	82.0%	92.0%	Non-NASH: ETOH
3-yr	79.0%	86.0%	NASH group
5-yr	75.0%	86.0%	Higher cardiovascular morbidity
9-yr	62.0%	76.0%	Higher risk of acute rejection and recurrent steatohepatitis
Barrit et al[28]
30-d	81.0%	97.0%	NASH group: Increased early mortality
1-yr	76.0%	89.5%	All recipients: Diabetes, risk factor for increased 3-yr mortality
3-yr	76.0%	83.5%
Afzali et al[29]
1-yr	87.6%		Non-NASH: Any other indication
3-yr	82.2%	Variable	NASH group: Excellent survival, similar to PSC and HBV
5-yr	76.7%
Singal et al[30]
1-yr	89.0%		Non-NASH: PSC, PBC, ALD, HCV, HBV, CC, HCC
3-yr	85.5%	Variable	NASH group: Excellent survival, 3-, 5-yr survival best of all
5-yr	84.0%
10-yr	84.0%

Post-LT: Post liver transplantation; NAFLD: Nonalcoholic fatty liver disease; NASH: Nonalcoholic steatohepatitis; PSC: Primary sclerosing cholangitis; PBC: Primary biliary cirrhosis; ALD: Alcoholic liver disease (ETOH); HCV: Hepatitis C virus; HBV: Hepatitis B virus; CC: Cryptogenic cirrhosis; HCC: Hepatocellular carcinoma.