BACKGROUND & AIMS: Little is known about outcomes of liver transplantation for patients with non-alcoholic steatohepatitis (NASH). We aimed to determine the frequency and outcomes of liver transplantation for patients with NASH in Europe and identify prognostic factors. METHODS: We analysed data from patients transplanted for end-stage liver disease between January 2002 and December 2016 using the European Liver Transplant Registry database. We compared data between patients with NASH versus other aetiologies. The principle endpoints were patient and overall allograft survival. RESULTS: Among 68,950 adults undergoing first liver transplantation, 4.0% were transplanted for NASH - an increase from 1.2% in 2002 to 8.4% in 2016. A greater proportion of patients transplanted for NASH (39.1%) had hepatocellular carcinoma (HCC) than non-NASH patients (28.9%, p <0.001). NASH was not significantly associated with survival of patients (hazard ratio [HR] 1.02, p = 0.713) or grafts (HR 0.99; p = 0.815) after accounting for available recipient and donor variables. Infection (24.0%) and cardio/cerebrovascular complications (5.3%) were the commonest causes of death in patients with NASH without HCC. Increasing recipient age (61-65 years: HR 2.07, p <0.001; >65: HR 1.72, p = 0.017), elevated model for end-stage liver disease score (>23: HR 1.48, p = 0.048) and low (<18.5 kg/m2: HR 4.29, p = 0.048) or high (>40 kg/m2: HR 1.96, p = 0.012) recipient body mass index independently predicted death in patients transplanted for NASH without HCC. Data must be interpreted in the context of absent recognised confounders, such as pre-morbid metabolic risk factors. CONCLUSIONS: The number and proportion of liver transplants performed for NASH in Europe has increased from 2002 through 2016. HCC was more common in patients transplanted with NASH. Survival of patients and grafts in patients with NASH is comparable to that of other disease indications. LAY SUMMARY: The prevalence of non-alcoholic fatty liver disease has increased dramatically in parallel with the worldwide increase in obesity and diabetes. Its progressive form, non-alcoholic steatohepatitis, is a growing indication for liver transplantation in Europe, with good overall outcomes reported. However, careful risk factor assessment is required to maintain favourable post-transplant outcomes in patients with non-alcoholic steatohepatitis.

Cambridge Transplant Centre Cambridge University Hospitals NHS Foundation Trust Cambridge UK

Centre for Liver and Gastroenterology Research Institute of Immunology and Immunotherapy University of Birmingham Birmingham UK; Liver Unit University Hospitals Birmingham NHS Foundation Trust Birmingham UK

Department of Medical Statistics Informatics and Health Economics Innsbruck Medical University Innsbruck Austria

Department of Surgery Campus Charité Mitte and Campus Virchow Klinikum Charité Universitätsmedizin Berlin Berlin Germany

Department of Visceral and Transplant Surgery University Hospital Essen Essen Germany

Department of Visceral Transplant and Thoracic Surgery Innsbruck Medical University Innsbruck Austria

Department of Visceral Transplant and Thoracic Surgery Innsbruck Medical University Innsbruck Austria; Department of Surgery Campus Charité Mitte and Campus Virchow Klinikum Charité Universitätsmedizin Berlin Berlin Germany; Berlin Institute of Health Berlin Germany

Division of Transplantation Department of Surgery Medical University of Vienna Währinger Gürtel Vienna Austria

Hepato Biliary Center AP HP Paul Brousse Hospital University of Paris Sud Inserm U776 Villejuif France

Institute of Clinical and Experimental Medicine Transplant Center Prague Czech Republic

Institute of Translational Medicine Queen Elizabeth Hospital Birmingham University Hospitals Birmingham Mindelsohn Way Birmingham UK

King's Liver Transplant Unit King's College Hospital NHS Foundation Trust London UK

Laboratory of Abdominal Transplantation Universitaire Zeikenhuizen Leuven Leuven Belgium

Liver Transplantation Center Florence Nightingale Hospital Istanbul Turkey

MRC Centre for Inflammation Research and Royal Infirmary University of Edinburgh Edinburgh UK

National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham Birmingham UK; Centre for Liver and Gastroenterology Research Institute of Immunology and Immunotherapy University of Birmingham Birmingham UK; Liver Unit University Hospitals Birmingham NHS Foundation Trust Birmingham UK

National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham Birmingham UK; Liver Unit University Hospitals Birmingham NHS Foundation Trust Birmingham UK

Service De Chirurgie Digestive Hopital Henri Mondor Creteil France

Sheila Sherlock Liver Centre Royal Free London NHS Foundation Trust London UK

Shiraz Organ Transplant IJOTM Office Namazi Hospital Shiraz Iran

The Leeds Teaching Hospitals NHS Trust Leeds UK

Universitatsklinikum Jena Allgemeine Viszerale und Transplantationschirurgie Jena Germany

Universitatsklinikum Leipzig Chirurgische Klinik Und Poliklinik Ii Visceral Transplantations Thorax und Gefabchirurgie Leipzig Germany

J Hepatol. 2019 Aug;71(2):240-242. doi: 10.1016/j.jhep.2019.05.018. PubMed

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