Cardiovascular mortality among liver transplant recipients with nonalcoholic steatohepatitis in the United States—a retrospective study

Summary Nonalcoholic steatohepatitis ( NASH ) has become an increasingly important indication for liver transplantation ( LT ), and there has been a particular concern of excessive cardiovascular‐related mortality in this group. Using the United Network for Organ Sharing‐Standard Transplant Analysis and Research ( UNOS STAR ) dataset, we reviewed data on 56,995 adult transplants (January 2002 through June 2013). A total of 3,170 NASH liver‐only recipients were identified and were matched with 3,012 non‐ NASH HCV + and 3,159 non‐ NASH HCV − controls [matched 1:1 based on gender, age at LT (±3 years), and MELD score (±3)]. Cox regression analysis revealed significantly lower hazard of all‐cause ( HR 0.669; P < 0.0001) and cardiovascular‐related mortality ( HR 0.648; P < 0.0001) in the NASH compared to the non‐ NASH group after adjusting for diabetes, BMI , and race. Relative to the non‐ NASH HCV ‐positive group, NASH group has lower hazard of all‐cause ( HR 0.539; P < 0.0001) and cardiovascular‐related mortality ( HR 0.491; P < 0001). A lower hazard of all‐cause mortality ( HR 0.844; P = 0.0094) was also observed in NASH patients compared to non‐ NASH HCV ‐negative group, but cardiovascular mortality was similar ( HR 0.892; P = 0.3276). LT recipients with NASH have either lower or similar risk of all‐cause and cardiovascular‐related mortality compared to its non‐ NASH counterparts after adjusting for diabetes, BMI , and race.