Departments of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Nonalcoholic steatohepatitis (NASH) is an independent predictor of coronary artery disease. Our aim was to compare the incidence of cardiovascular (CV) events between patients transplanted for NASH and alcohol (ETOH) induced cirrhosis.
This is a retrospective cohort study (8/1993 - 3/2010) of 242 patients (115 NASH, 127 ETOH) with ≥ 12 months follow-up after liver transplantation (LT). Those with hepatocellular carcinoma or co-existing liver diseases were excluded. Kaplan-Meier and Cox proportional hazard analyses were conducted to compare survival. Logistic regression was used to calculate likelihood of CV events, defined as death from any cardiac cause, myocardial infarction, acute heart failure, cardiac arrest, arrhythmia, complete heart block, and/or stroke requiring hospitalization < 1 yr after LT.
Patients in the NASH group were older: 58.4 vs. 53.3 years and more likely to be female: 45% vs. 18% (p<0.001). They were more likely to be morbidly obese (32% vs. 9%), have dyslipidemia (25% vs. 6%) or have HTN (53% vs. 38%, p<0.01). On multivariate analysis, NASH patients were more likely to have a CV event < 1 year after LT compared to ETOH patients even after controlling for recipient age, sex, smoking status, pre-transplant diabetes, CV disease and the presence of the metabolic syndrome (26% vs. 8%, OR=4.12, 95% CI=1.91-8.90). The majority (70%) of events occurred in the peri-operative period and the occurrence of a CV event was associated with a 50% overall mortality. However, there were no differences in patient, graft or CV mortality between the groups.
Cardiovascular complications are common following LT, and NASH patients are at increased risk independent of traditional cardiac risk factors though this did not impact overall mortality.