925 Early Cardiovascular Disease Mortality After Liver Transplantation—Is Nonalcoholic Steatohepatitis (NASH) to Blame?

Abstract

BACKGROUND: Nonalcoholic steatohepatitis (NASH) is independently associated with an increased risk of cardiovascular disease (CVD). However, whether this association affects perioperative liver transplant (LT) outcomes is unknown. Thus, we examined the association between NASH and early CVD mortality after LT. METHODS: A cohort of 6,932 adults with NASH or cryptogenic cirrhosis thought secondary to NASH who underwent first LT from 2/2002-12/2012 was identified using the U.S. Organ Procurement and Transplantation Network (OPTN) database. Those listed as status 1 or prior to MELD inception were excluded. Recipient cause of death was manually reviewed and a physician panel adjudicated cases. Logistic regression models examined associations between NASH and early (30day) CVD mortality, defined as primary cause of death from arterial/pulmonary embolism, arrhythmia, heart failure, myocardial infarction, cardiac arrest and/or stroke. Kaplan-Meier analysis assessed survival. RESULTS: NASH patients were older (57.4 vs. 52.9 years), more likely to be female (43.3% vs. 30.9%), obese (BMI ≥ 30 mg/kg2, 51.8% vs. 30.5%), and have diabetes (46.2% vs. 21.1%) compared to non-NASH (p<0.001). Although there was no significant difference in long-term all-cause mortality (log-rank, p=0.714), early all-cause mortality was increased in NASH compared to non-NASH (3.4% vs. 2.6%, p=0.03). Of 235 early NASH deaths, 107 (40.5%) were CVD-related. In multivariable analyses adjusted for age, sex, diabetes and BMI, NASH was associated with an increased risk of early CVD mortality (OR=1.26, 95% CI: 1.01-1.58). CONCLUSION: NASH is associated with an increased risk of early CVD-related mortality despite acceptable long-term outcomes. Future studies that address the high prevalence of cardiovascular comorbid conditions in this rapidly growing patient population are needed to potentially reduce early mortality after liver transplantation for NASH cirrhosis.