Abstract：
Introduction: Non-Alcoholic Steatohepatitis is an increasing reason for liver transplantation in the western world. Knowledge of recipient life expectancy may assist in prudent allocation of a relatively scarce supply of donor livers. Research Questions: We calculated life expectancies for Non-alcoholic steatohepatitis (NASH) patients both at time of transplant and one year later, stratified by key risk factors, and examined whether survival has improved in recent years. Design: Data on 6635 NASH patients who underwent liver transplantation in the MELD era (2002-2018) from the United States OPTN database were analyzed using the Cox proportional hazards regression model and life table methods. Results: Factors related to survival were age, presence of diabetes or hepatic encephalopathy (HE), and whether the patient required dialysis in the week prior to transplant. Other important factors were whether the patient was working, hospitalization prior to transplant, ventilator support, and length of hospital stay (LOS). Survival improved over the study period at roughly 4.5% per calendar year during the first year posttransplant, though no improvement was observed in those who had survived one year. Conclusion: Life expectancy in NASH transplant patients was much reduced from normal, and varied according to age, medical factors, status at transplant, and post transplant course. Over the 17-year study period, patient survival improved markedly during the first year posttransplant, though not thereafter. The results given here may prove helpful in medical decision-making regarding treatment for both liver disease and other medical conditions, as they provide both clinicians and their patients with evidence-based information on prognosis.
摘要：
简介：在西方世界，非酒精性脂肪性肝炎是肝移植的原因之一。了解接受者的预期寿命可能有助于谨慎分配相对稀缺的供体肝脏。研究问题：我们计算了非酒精性脂肪性肝炎（NASH）患者在移植时和一年后的预期寿命，按关键风险因素分层，并检查了近年来生存率是否有所改善。设计：使用Cox比例风险回归模型和生命表方法分析了来自美国OPTN数据库的6635名在MELD时代（2002-2018）接受肝移植的NASH患者的数据。结果：与生存有关的因素是年龄，存在糖尿病或肝性脑病（HE），以及患者在移植前一周是否需要透析。其他重要因素是病人是否在工作，移植前住院，呼吸机支持,住院时间（LOS）。在移植后的第一年中，生存率在研究期间提高了约4.5%，每个日历年。尽管在存活一年的人中没有观察到任何改善。结论：NASH移植患者的预期寿命从正常水平大大降低，根据年龄的不同，医疗因素,移植状态，和移植后的课程。在17年的研究期间，在移植后的第一年，患者的生存率显着提高，但此后没有。此处给出的结果可能有助于有关肝病和其他医疗状况的治疗的医疗决策。因为他们为临床医生及其患者提供了基于证据的预后信息.
