Nonalcoholic steatohepatitis is the most rapidly growing indication for simultaneous liver kidney transplantation in the United States

Ashwani Kumar Singal, Mohsen Hasanin, Mohamed Kaif, Russell Wiesner, Yong Fang Kuo

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background. Frequency of liver transplantation (LT) is increasing in nonalcoholic steatohepatitis (NASH) with good posttransplant outcomes. Similar data on simultaneous liver kidney (SLK) transplants are limited. Methods. United Network for Organ Sharing database (2002-2011) queried for deceased donor first LT for primary biliary cirrhosis, primary sclerosing cholangitis, or alcoholic cirrhosis (group I), NASH, and cryptogenic cirrhosis with body mass index greater than 30 (group II), and hepatitisC virus with and without alcohol, hepatitis B virus, and hepatocellular carcinoma (group III). Results. Of 38 533 LT (9495, 3665, and 25 383 in groups I-III, respectively), about 5.6% (N = 2162) received SLK with 584 (6.2%), 320 (8.7%), and 1258 (5%) in groups I-III, respectively. The SLK performed for group II increased from 6.3% in 2002 to 2003 to 19.2% in 2010 to 2011. Similar trends remained unchanged in group I (26.1 to 26.6%) and decreased in group III (67.6 to 54.5%). Five-year outcomes were similar comparing group II versus group I for liver graft (78 vs 74%, P = 0.14) and patient survival (81 vs 76%, P = 0.07). In contrast, kidney graft outcome was worse for group II (70 vs 79%, P = 0.002). Risk of kidney graft loss was over 1.5-fold higher among group II SLK recipients compared to group I after controlling for recipient characteristics. Estimated glomerular filtration rate remained lower in group II compared with group I at various time points after SLK transplantation. Conclusions. The NASH is the most rapidly growing indication for SLK transplantation with poor renal outcomes. Studies are needed to examine mechanisms of these findings and develop strategies to improve renal outcomes in SLK recipients for NASH.

Original languageEnglish (US)
Pages (from-to)607-612
Number of pages6
JournalTransplantation
Volume100
Issue number3
DOIs
StatePublished - 2016

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Liver Transplantation
Kidney Transplantation
Kidney
Liver
Transplants
Non-alcoholic Fatty Liver Disease
Alcoholic Liver Cirrhosis
Sclerosing Cholangitis
Biliary Liver Cirrhosis
Glomerular Filtration Rate
Hepatitis B virus
Hepatocellular Carcinoma
Body Mass Index
Alcohols
Tissue Donors
Databases
Viruses
Survival

ASJC Scopus subject areas

  • Transplantation

Cite this

Nonalcoholic steatohepatitis is the most rapidly growing indication for simultaneous liver kidney transplantation in the United States. / Singal, Ashwani Kumar; Hasanin, Mohsen; Kaif, Mohamed; Wiesner, Russell; Kuo, Yong Fang.

In: Transplantation, Vol. 100, No. 3, 2016, p. 607-612.

Research output: Contribution to journalArticle

Singal, Ashwani Kumar ; Hasanin, Mohsen ; Kaif, Mohamed ; Wiesner, Russell ; Kuo, Yong Fang. / Nonalcoholic steatohepatitis is the most rapidly growing indication for simultaneous liver kidney transplantation in the United States. In: Transplantation. 2016 ; Vol. 100, No. 3. pp. 607-612.
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abstract = "Background. Frequency of liver transplantation (LT) is increasing in nonalcoholic steatohepatitis (NASH) with good posttransplant outcomes. Similar data on simultaneous liver kidney (SLK) transplants are limited. Methods. United Network for Organ Sharing database (2002-2011) queried for deceased donor first LT for primary biliary cirrhosis, primary sclerosing cholangitis, or alcoholic cirrhosis (group I), NASH, and cryptogenic cirrhosis with body mass index greater than 30 (group II), and hepatitisC virus with and without alcohol, hepatitis B virus, and hepatocellular carcinoma (group III). Results. Of 38 533 LT (9495, 3665, and 25 383 in groups I-III, respectively), about 5.6{\%} (N = 2162) received SLK with 584 (6.2{\%}), 320 (8.7{\%}), and 1258 (5{\%}) in groups I-III, respectively. The SLK performed for group II increased from 6.3{\%} in 2002 to 2003 to 19.2{\%} in 2010 to 2011. Similar trends remained unchanged in group I (26.1 to 26.6{\%}) and decreased in group III (67.6 to 54.5{\%}). Five-year outcomes were similar comparing group II versus group I for liver graft (78 vs 74{\%}, P = 0.14) and patient survival (81 vs 76{\%}, P = 0.07). In contrast, kidney graft outcome was worse for group II (70 vs 79{\%}, P = 0.002). Risk of kidney graft loss was over 1.5-fold higher among group II SLK recipients compared to group I after controlling for recipient characteristics. Estimated glomerular filtration rate remained lower in group II compared with group I at various time points after SLK transplantation. Conclusions. The NASH is the most rapidly growing indication for SLK transplantation with poor renal outcomes. Studies are needed to examine mechanisms of these findings and develop strategies to improve renal outcomes in SLK recipients for NASH.",
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AU - Singal, Ashwani Kumar

AU - Hasanin, Mohsen

AU - Kaif, Mohamed

AU - Wiesner, Russell

AU - Kuo, Yong Fang

PY - 2016

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N2 - Background. Frequency of liver transplantation (LT) is increasing in nonalcoholic steatohepatitis (NASH) with good posttransplant outcomes. Similar data on simultaneous liver kidney (SLK) transplants are limited. Methods. United Network for Organ Sharing database (2002-2011) queried for deceased donor first LT for primary biliary cirrhosis, primary sclerosing cholangitis, or alcoholic cirrhosis (group I), NASH, and cryptogenic cirrhosis with body mass index greater than 30 (group II), and hepatitisC virus with and without alcohol, hepatitis B virus, and hepatocellular carcinoma (group III). Results. Of 38 533 LT (9495, 3665, and 25 383 in groups I-III, respectively), about 5.6% (N = 2162) received SLK with 584 (6.2%), 320 (8.7%), and 1258 (5%) in groups I-III, respectively. The SLK performed for group II increased from 6.3% in 2002 to 2003 to 19.2% in 2010 to 2011. Similar trends remained unchanged in group I (26.1 to 26.6%) and decreased in group III (67.6 to 54.5%). Five-year outcomes were similar comparing group II versus group I for liver graft (78 vs 74%, P = 0.14) and patient survival (81 vs 76%, P = 0.07). In contrast, kidney graft outcome was worse for group II (70 vs 79%, P = 0.002). Risk of kidney graft loss was over 1.5-fold higher among group II SLK recipients compared to group I after controlling for recipient characteristics. Estimated glomerular filtration rate remained lower in group II compared with group I at various time points after SLK transplantation. Conclusions. The NASH is the most rapidly growing indication for SLK transplantation with poor renal outcomes. Studies are needed to examine mechanisms of these findings and develop strategies to improve renal outcomes in SLK recipients for NASH.

AB - Background. Frequency of liver transplantation (LT) is increasing in nonalcoholic steatohepatitis (NASH) with good posttransplant outcomes. Similar data on simultaneous liver kidney (SLK) transplants are limited. Methods. United Network for Organ Sharing database (2002-2011) queried for deceased donor first LT for primary biliary cirrhosis, primary sclerosing cholangitis, or alcoholic cirrhosis (group I), NASH, and cryptogenic cirrhosis with body mass index greater than 30 (group II), and hepatitisC virus with and without alcohol, hepatitis B virus, and hepatocellular carcinoma (group III). Results. Of 38 533 LT (9495, 3665, and 25 383 in groups I-III, respectively), about 5.6% (N = 2162) received SLK with 584 (6.2%), 320 (8.7%), and 1258 (5%) in groups I-III, respectively. The SLK performed for group II increased from 6.3% in 2002 to 2003 to 19.2% in 2010 to 2011. Similar trends remained unchanged in group I (26.1 to 26.6%) and decreased in group III (67.6 to 54.5%). Five-year outcomes were similar comparing group II versus group I for liver graft (78 vs 74%, P = 0.14) and patient survival (81 vs 76%, P = 0.07). In contrast, kidney graft outcome was worse for group II (70 vs 79%, P = 0.002). Risk of kidney graft loss was over 1.5-fold higher among group II SLK recipients compared to group I after controlling for recipient characteristics. Estimated glomerular filtration rate remained lower in group II compared with group I at various time points after SLK transplantation. Conclusions. The NASH is the most rapidly growing indication for SLK transplantation with poor renal outcomes. Studies are needed to examine mechanisms of these findings and develop strategies to improve renal outcomes in SLK recipients for NASH.

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