Abstract
Background Nonalcoholic steatohepatitis (NASH) and alcoholic liver disease (ALD) are now the
most common indications for liver transplantation (LT) in the United States. A subset
of patients have both alcoholic and nonalcoholic steatohepatitis (BASH). This study
characterizes patients with BASH requiring LT and assesses changes in the prevalence
of BASH as an indication for LT.
Methods The United Network for Organ Sharing database was analyzed for all patients ≥ 18
years of age who received their first deceased donor LT from 2002 to 2016 for ALD,
NASH, or BASH. Baseline demographics, clinical parameters, and LT outcomes were compared
between groups.
Results Since 2002, 85,448 patients underwent LT:15,327 had ALD, 9,971 had NASH, and 2,779
had BASH. The prevalence of BASH as an indication for LT increased from 0.5% in 2002
to 5% in 2016. Compared with patients with NASH, those with BASH were significantly
more likely to be male (85.6 vs. 57%), younger (mean 56.4 vs. 58.6 years), and Hispanic
(22.2 vs. 13.6%) (p < 0.001 for all). While indication for transplant was not significantly associated
with transplant outcomes on multivariable analysis, patient and graft survival curves
do differ significantly by indication for transplant, with worse outcomes for patients
with BASH (patient survival at 5 years: NASH 78.1%, ALD 77.2%, BASH 73.5%, p = 0.013; graft survival at 5 years: NASH 75.3%, ALD 74.0%, BASH 70.8%, p = 0.046).
Conclusions BASH is a rising indication for LT, especially for Hispanic males, due to the increasing
prevalence of ALD and NASH in the United States.
Keywords
NAFLD - NASH - liver transplant
