Advanced non-alcoholic steatohepatitis cirrhosis: A high-risk population for pre-liver transplant portal vein thrombosis

Table 1 Baseline characteristics comparing non-alcoholic steatohepatitis recipients to all other etiologies of liver disease n (%)

	NASH (n = 3240)	Other etiologies (n = 31832)	P value
Recipient characteristics
Age at listing, mean years (95%CI)	57.6 (57.3-57.9)	52.2 (52.1-52.3)	< 0.001
Age at transplant, mean years (95%CI)	58.1 (57.8-58.4)	52.7 (52.6-52.8)	< 0.001
Male gender	1747 (52.9)	22099 (67.3)	< 0.001
African American race	65 (2.0)	3.559 (10.9)	< 0.001
Hispanic race	348 (10.5)	4009 (12.2)	0.005
BMI at transplant, kg/m2, mean (95%CI)	32.3 (32.0-32.5)	27.8 (27.7-27.9)	< 0.001
Hypertension requiring medical treatment	160 (33.2)	2155 (19.2)	< 0.001
Diabetes	1698 (51.4)	6211 (18.9)	< 0.001
Portal vein thrombosis	394 (12.2)	2232 (7.1)	< 0.001
Etiology of liver disease
Alcohol alone		6236 (19.0)
Autoimmune disease		1.202 (3.7)
Cholestatic disease		3638 (11.1)
Hepatitis B		986 (3.0)
Hepatitis C		15298 (46.6)
Other		4472 (14.0)
Severity of liver disease
MELD score at listing, mean (95%CI)	20.0 (19.8-20.3)	19.6 (19.5-19.7)	0.014
MELD score at transplantation, mean (95%CI)	23.5 (23.2-23.8)	22.8 (22.7-22.9)	< 0.001
Laboratory values
Serum bilirubin, mg/dL, mean (95%CI)	7.4 (7.1-7.8)	9.1 (9.0-9.2)	< 0.001
INR, mean (95%CI)	1.92 (1.90-1.95)	1.93 (1.92-1.94)	NS
Serum albumin, g/dL, mean (95%CI)	3.0 (3.0-3.1)	3.0 (2.9-3.0)	0.002
Creatinine, g/dL, mean (95%CI)	1.81 (1.76-1.86)	1.65 (1.63-1.67)	< 0.001
On dialysis at transplantation	488 (10.6)	4135 (12.2)	< 0.001
Portal hypertension manifestations
Moderate-severe ascites at transplant	1210 (36.7)	10782 (32.9)	< 0.001
Moderate-severe hepatic encephalopathy at transplant	375 (11.7)	3708 (11.3)	NS

In general, NASH recipients were older, more likely to be female, less likely to be African American or Hispanic, had higher BMI values and were more likely to have diabetes, hypertension and renal dysfunction. BMI: Body mass index; NASH: Non-alcoholic steatohepatitis; NS: Not significant; INR: International normalized ratio; MELD: Model for end-stage liver disease.

Table 2 Baseline characteristics comparing high-risk non-alcoholic steatohepatitis to low-risk non-alcoholic steatohepatitis recipients

	High-risk NASH (n = 465)	Low-risk NASH (n = 2775)	P value
Recipient characteristics
Age at listing, mean years (95%CI)	64.0 (63.8-64.3)	56.7 (56.2-56.9)	< 0.001
Age at transplant, mean years (95%CI)	64.5 (64.2-64.7)	57.0 (56.8-57.4)	< 0.001
Male gender	247 (52.4)	1500 (53.0)	NS
African American race	7 (0.2)	58 (1.6)	NS
Hispanic race	43 (9.1)	305 (10.8)	NS
BMI at transplant, kg/m2, mean (95%CI)	35.1 (34.7-35.5)	31.8 (31.5-32.0)	< 0.001
Portal vein thrombosis	66 (14.2)	326 (11.8)	NS
Severity of liver disease
MELD score at listing, mean (95%CI)	19.5 (18.7-20.3)	20.1 (19.8-20.4)	NS
MELD score at transplantation, mean (95%CI)	22.8 (21.9-23.6)	23.7 (23.3-24.0)	NS
Laboratory values
Serum bilirubin, mg/dL, mean (95%CI)	6.2 (5.4-7.0)	7.7 (7.3-8.0)	0.002
INR, mean (95%CI)	1.81 (1.75-1.86)	1.94 (1.91-1.97)	0.002
Serum albumin, g/dL, mean (95%CI)	3.1 (3.0-3.2)	3.0 (2.9-3.1)	0.006
Creatinine, g/dL, mean (95%CI)	1.98 (1.85-2.11)	1.78 (1.73-1.83)	0.003
On dialysis at transplantation	73 (15.5)	415 (14.7)	NS
Portal hypertension manifestations
Moderate-severe ascites at transplant	178 (37.8)	1032 (36.5)	NS
Moderate-severe hepatic encephalopathy at transplant	51 (10.8)	324 (11.5)	NS

HR-NASH recipients were older, had higher BMI values and were more likely to have renal dysfunction. BMI: Body mass index; HR: High-risk; NASH: Non-alcoholic steatohepatitis; NS: Not significant; INR: International normalized ratio.

Table 3 Adjusted multivariable analysis for predictors of portal vein thrombosis at the time of liver transplantation

	Odds ratio	95%CI	P value
African American race	0.75	0.64-0.89	< 0.001
AIH	1.43	1.14-1.79	0.002
Hispanic race	1.24	1.10-1.39	< 0.001
HR-NASH	2.11	1.60-2.76	< 0.001
LR-NASH	1.71	1.49-1.96	< 0.001
Male gender	1.18	1.07-1.29	< 0.001
Moderate-severe ascites	1.14	1.04-1.25	0.007

Recipients with HR-NASH had the greatest risk of pre-transplant PVT when referenced both to the non-NASH cohort and to LR-NASH recipients. Variables that were not significant in the model: Albumin levels, bilirubin levels, cholestatic liver disease, creatinine levels, hepatitis C, international normalized ratio (INR); moderate-severe encephalopathy, pre-transplant dialysis treatment, sodium levels. AIH: Autoimmune hepatitis; HR: High-risk; LR: Low-risk; NASH: Non-alcoholic steatohepatitis.