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Liver transplant survival higher among patients with NASH, HBV; lower for HCV, HCC

LAS VEGAS — Patients who underwent liver transplantation to treat nonalcoholic steatohepatitis, HBV or alcoholic liver disease had higher survival rates than those treated for HCV or hepatocellular carcinoma, according to data presented at the 2012 American College of Gastroenterology Annual Scientific Meeting.

Researchers determined the graft and patient survival rates of patients who underwent liver transplant for alcoholic liver disease (ALD; n=8,940), primary biliary cirrhosis (PBC; n=3,052), cryptogenic cirrhosis (CC; n=5,856), primary sclerosing cholangitis (PSC; n=3,854), HCV (n=15,147) or HBV (n=1,816) infection, a combination of alcohol-related illness and HCV (n=6,066), nonalcoholic steatohepatitis (NASH; n=1,368) and hepatocellular carcinoma (HCC; n=8,588).

“Data are unclear on the impact of last-decade evolutions on liver graft and patient survival depending on the etiology of cirrhosis,” researcher Habeeb Salameh, MBBS, department of internal medicine at the University of Texas Medical Branch in Galveston, told Healio.com. “These evolutions include [the] introduction of MELD score for listing, HCC appeal criteria for MELD exception points, and the listing of NASH as a distinct etiology of cirrhosis.”

Habeeb Salameh

The number of performed liver transplants increased from 2,906 in 1994 to 5,357 in 2009, with more procedures performed to treat NASH, HCC and alcohol/HCV, fewer performed to treat PBC, PSC, CC and HBV or HCV infection, and a similar number for ALD. Investigators noted that simultaneous liver and kidney (SLK) transplants made up a larger amount of total procedures after the introduction of MELD score (2.5% of procedures in 2001 compared with 10.3% in 2009).

Salameh attributed the increase in transplants for NASH to the prevalence of obesity in the United States, and noted that the condition is projected to overtake HCV as a transplant indication by 2020. The decrease in transplants performed for HBV and PBC, he added, is likely the result of other potent treatments developed for both illnesses.

Survival rates at 5 years were between 75% and 80% for graft and 80% and 85% for patient survival among those receiving transplant for PBC, PSC, NASH or HBV infection, and between 70% and 75% (HR=1-1.5 compared with PBC) for graft and 75% and 80% (HR=1.5-2.0) for patient survival in ALD or CC. Survival rates were lowest among patients treated for HCC, HCV or combined alcohol consumption/HCV (65%-70%; HR=1.5-2.4 for graft and 70%-75%, HR=1.8-2.3 for patient survival), and were particularly low in patients with HCV-associated HCC.

“This study clearly shows excellent post-transplant outcomes of patients transplanted for ALD,” Salameh said. “With the emerging data on beneficial outcomes of liver transplant for patients with severe alcoholic hepatitis who do not respond to medical management, transplants are likely to be more widely accepted in the near future.”

For more information:

Salameh H. P234: Evolving Frequency with Graft and Patient Survival of Liver Transplantation Based on Etiology of Liver Disease. Presented at: the 2012 American College of Gastroenterology Annual Scientific Meeting; Oct. 19-24, Las Vegas.