Sa1590 DEPRESSION IS ASSOCIATED WITH WEIGHT GAIN IN PATIENTS TRANSPLANTED FOR NASH CIRRHOSIS BUT NOT OTHER ETIOLOGIES OF CIRRHOSIS

Background: Weight gain after liver transplantation (LT) is common, particularly in patients transplanted for NASH cirrhosis, and is associated with reduced survival.While immunosuppressant use is often implicated as a key driver of post-LT weight gain, published literature has failed to support this assertion.In non-LT patients, presence and sub-optimal management of depression is closely associated with weight gain and obesity.The impact of depression as predictor of post-LT weight gain is currently not known.Thus, the aim of the present study was to bridge this gap in knowledge by evaluating the relationship between depression, liver disease and weight change after LT.Method: All adult patients receiving LT between 7/2007 to 7/2017 were included in the analysis (N= 384).Patients with graft failure or death within 6 months after LT were excluded.Baseline weight was weight 2 weeks after LT to avoid contribution of peri-transplant ascites or edema.Screening for depression was performed by a board-certified transplant psychologist or psychiatrist using DSM-IV/V guidelines.Antidepressant use was quantified through chart review of the medication list and pharmacy record.Results: The most common etiology of chronic liver disease included hepatitis C (HCV) (n=227), NASH (n=79) and alcohol (n=78) with a median follow up of 54 months (IQR 36, 60).The mean age for LT was 57±6.9 and similar across other etiologies of cirrhosis.The prevalence of depression at LT was 30.2% in HCV, 35.5% in NASH and 26.1% in alcohol cirrhosis (P=0.46).At the time of LT, the prevalence of obesity was higher in patients receiving LT for NASH cirrhosis compared to HCV and alcohol (33.8% vs. 21.9% vs. 15.1%;p=0.02).Presence of depression at LT was not predictive of post-LT weight gain (Fig. 1A).When stratified according to liver disease, depression did not affect weight change in patients transplanted for HCV and alcoholic cirrhosis; however, in patients transplanted for NASH cirrhosis depression was positively associated with post-LT weight gain up to 60 months post-LT (Fig. 1B).Furthermore, in patients receiving any therapy for depression, the weight gain was mitigated, whereas in patients with NASH cirrhosis and depression not on anti-depressants the weight gain was significantly more profound at each follow up ( Fig. 1C).The relationship between depression, NASH, and weight gain after LT was independent of presence of diabetes, hypertension, age, gender, ethnicity, choice of immunosuppression and BMI at the time of LT.Conclusion Presence and under-treatment of depression are associated with more profound weight gain in patients transplanted for NASH cirrhosis, likely reflecting poor coping mechanisms.Additional trials with aggressive screening and treatment of depression in patients transplanted for NASH cirrhosis are essential to mitigate post-LT weight gain