Liver Transplantation in Cryptogenic Cirrhosis: Outcome comparisons between NASH, Alcoholic and AIH cirrhosis

ABSTRACT Background The outcomes of liver transplantation (LT) in patients with cryptogenic cirrhosis (CC) have not been adequately examined except for small case series. We believe that patients currently listed as CC have truly cryptogenic liver disease and may have different post-LT outcomes compared to nonalcoholic steatohepatitis (NASH). Methods: We compared the post-LT outcomes of adults with CC (n=3241) and compared them with cirrhosis from NASH (n=4089), alcohol (AC, n=7837) and autoimmune hepatitis (AIH, n=1435) using the UNOS database from 2002-16. We excluded those who had multi-organ transplantation and hepatocellular carcinoma. In addition to the well-known predictors of liver transplant outcomes, we analyzed the impact of Karnofsky Performance Status (KPS) score at LT on immediate and late outcomes. Results There were significant differences in clinical characteristics between the groups. Despite these differences in clinical characteristics and risk factors, CC had similar graft and patient survival to NASH, AC and AIH when assessed by Kaplan-Meier survival. Multivariate Cox regression analysis showed that graft and patient survival was similar in all 4 groups after adjusting for other confounders. Hispanics had a 24% lower risk of death (Hazard Ratio {HR} 0.76) compared to Whites in these combined cohorts after adjusting for all risk factors. In addition to other known risk factors, KPS score of 30% or less was associated with a 33% increase in risk of death (HR 1.33) on multivariate analysis. Conclusion Patients with CC had similar graft and patient survival when compared to NASH, AC and AIH cirrhosis. Address for correspondence: Paul J. Thuluvath, MD, FAASLD, FRCP, Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD 21202, Tel: 410 332 9308; Fax: 410 659 1178; Email: thuluvath@gmail.com Conflicts of interest: None; Financial support: None Contributions: PJT and SH contributed to the idea, YS did the statistical analysis, PJT wrote the manuscript, SH and YS reviewed the final manuscript Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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