Predicting the outcome of liver transplantation in patients with non‐alcoholic steatohepatitis cirrhosis: The NASH LT risk‐benefit calculator.

Background: Non‐alcoholic Steatohepatitis (NASH) cirrhosis is the second most common indication for liver transplantation (LT) in the US and often is associated with significant co‐morbidities. We validated a model and risk prediction score that reflects the benefit derived from LT for NASH cirrhosis by predicting 5‐year survival post‐LT. Methods: We developed a prediction score utilizing 6515 NASH deceased donor LT (DDLT) recipients from 2002 to 2019 from the Scientific Registry of Transplant Recipients (SRTR) database to identify a parsimonious set of independent predictors of survival. Coefficients of relevant recipient factors were converted to weighted points to construct a risk scoring system that was then externally validated. Results: The final risk score includes the following independent recipient predictors and corresponding points: recipient age (5 points for age ≥70 years), functional status (3 points for total assistance), presence of TIPSS (2 points), hepatic encephalopathy (1 point), serum creatinine (5 points if >1.45 mg/dl), need for mechanical ventilation (3 points), and dialysis within 1 week prior to LT (7 points). Diabetes is a stratifying variable for baseline risk. Scores range from 0 to 20 with scores above 13 having an overall survival of <65% at 5 years post‐LT. Internal and external validation indicated good predictive ability. Conclusion: Our practically useable and validated risk score helps to identify and stratify candidates who will derive the most long‐term benefit from LT for NASH cirrhosis. [ABSTRACT FROM AUTHOR]