Published online Jan 28, 2017. doi: 10.4254/wjh.v9.i3.139
Peer-review started: April 26, 2016
First decision: July 20, 2016
Revised: October 25, 2016
Accepted: December 13, 2016
Article in press: December 14, 2016
Published online: January 28, 2017
To examine if liver transplant recipients with high-risk non-alcoholic steatohepatitis (NASH) are at increased risk for pre-transplant portal venous thrombosis.
Data on all liver transplants in the United States from February 2002 through September 2014 were analyzed. Recipients were sorted into three distinct groups: High-risk (age > 60, body mass index > 30 kg/m2, hypertension and diabetes), low-risk and non-NASH cirrhosis. Multivariable logistic regression models were constructed.
Thirty-five thousand and seventy-two candidates underwent liver transplantation and of those organ recipients, 465 were transplanted for high-risk and 2775 for low-risk NASH. Two thousand six hundred and twenty-six (7.5%) recipients had pre-transplant portal vein thrombosis; 66 (14.2%) of the high-risk NASH group had portal vein thrombosis vs 328 (11.8%) of the low-risk NASH group. In general, all NASH recipients were less likely to be male or African American and more likely to be obese. In adjusted multivariable regression analyses, high-risk recipients had the greatest risk of pre-transplant portal vein thrombosis with OR = 2.11 (95%CI: 1.60-2.76, P < 0.001) when referenced to the non-NASH group.
Liver transplant candidates with high-risk NASH are at the greatest risk for portal vein thrombosis development prior to transplantation. These candidates may benefit from interventions to decrease their likelihood of clot formation and resultant downstream hepatic decompensating events. Prospective study is needed.
Core tip: Non-alcoholic steatohepatitis (NASH) is increasing in prevalence and is expected to be the leading indication for liver transplantation in the foreseeable future. There is a growing body of evidence supporting the clinical importance of a thrombophilic state in patients with NASH. In NASH patients, the most severe hypercoagulable environment is found in patients with NASH cirrhosis. High-risk NASH patients (concomitant age > 60 years, obesity, diabetes and hypertension) have inferior post transplantation outcomes, however, how this group’s risk of clotting compares to other etiologies of liver disease is unknown. In a retrospective nationwide United States based cohort, we provide further evidence of coagulation derangement in NASH and identify a new high-risk subtype in the high-risk NASH population. Whether or not this high-risk group may benefit from preventative anticoagulation remains unknown.