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J Hepatol. 2019 May 7. pii: S0168-8278(19)30272-7. doi: 10.1016/j.jhep.2019.04.011. [Epub ahead of print]

Outcomes of liver transplantation for non-alcoholic steatohepatitis: A European Liver Transplant Registry study.

Author information

1
National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK; Centre for Liver and Gastroenterology Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
2
Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria; Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany.
3
Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Mindelsohn Way, Birmingham, UK.
4
National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
5
Hepato-Biliary Center, AP-HP Paul Brousse Hospital, University of Paris-Sud, Inserm U776, Villejuif, France.
6
Division of Transplantation, Department of Surgery, Medical University of Vienna, Währinger Gürtel, Vienna, Austria.
7
Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria.
8
Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.
9
Centre for Liver and Gastroenterology Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
10
King's Liver Transplant Unit, King's College Hospital NHS Foundation Trust, London, UK.
11
Cambridge Transplant Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge UK.
12
MRC Centre for Inflammation Research and Royal Infirmary, University of Edinburgh, Edinburgh, UK.
13
Laboratory of Abdominal Transplantation, Universitaire Zeikenhuizen Leuven, Leuven, Belgium.
14
Shiraz Organ Transplant, IJOTM Office, Namazi Hospital, Shiraz, Iran.
15
The Leeds Teaching Hospitals NHS Trust, Leeds, UK.
16
Liver Transplantation Center, Florence Nightingale Hospital, Istanbul, Turkey.
17
Department of Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany.
18
Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.
19
Universitatsklinikum Leipzig, Chirurgische Klinik Und Poliklinik Ii Visceral, Transplantations, Thorax und Gefabchirurgie, Leipzig, Germany.
20
Institute of Clinical and Experimental Medicine, Transplant Center, Prague, Czech Republic.
21
Universitatsklinikum Jena, Allgemeine, Viszerale und Transplantationschirurgie, Jena, Germany.
22
Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, London, UK.
23
Service De Chirurgie Digestive, Hopital Henri Mondor, Creteil, France.
24
National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK; Centre for Liver and Gastroenterology Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. Electronic address: P.N.Newsome@bham.ac.uk.

Abstract

BACKGROUND & AIMS:

Little is known about outcomes of liver transplantation for patients with non-alcoholic steatohepatitis (NASH). We aimed to determine the frequency and outcomes of liver transplantation for patients with NASH in Europe and identify prognostic factors.

METHODS:

We analysed data from patients transplanted for end-stage liver disease between January 2002 and December 2016 using the European Liver Transplant Registry database. We compared data between patients with NASH versus other aetiologies. The principle endpoints were patient and overall allograft survival.

RESULTS:

Among 68,950 adults undergoing first liver transplantation, 4.0% were transplanted for NASH - an increase from 1.2% in 2002 to 8.4% in 2016. A greater proportion of patients transplanted for NASH (39.1%) had hepatocellular carcinoma (HCC) than non-NASH patients (28.9%, p <0.001). NASH was not significantly associated with survival of patients (hazard ratio [HR] 1.02, p = 0.713) or grafts (HR 0.99; p = 0.815) after accounting for available recipient and donor variables. Infection (24.0%) and cardio/cerebrovascular complications (5.3%) were the commonest causes of death in patients with NASH without HCC. Increasing recipient age (61-65 years: HR 2.07, p <0.001; >65: HR 1.72, p = 0.017), elevated model for end-stage liver disease score (>23: HR 1.48, p = 0.048) and low (<18.5 kg/m2: HR 4.29, p = 0.048) or high (>40 kg/m2: HR 1.96, p = 0.012) recipient body mass index independently predicted death in patients transplanted for NASH without HCC. Data must be interpreted in the context of absent recognised confounders, such as pre-morbid metabolic risk factors.

CONCLUSIONS:

The number and proportion of liver transplants performed for NASH in Europe has increased from 2002 through 2016. HCC was more common in patients transplanted with NASH. Survival of patients and grafts in patients with NASH is comparable to that of other disease indications.

LAY SUMMARY:

The prevalence of non-alcoholic fatty liver disease has increased dramatically in parallel with the worldwide increase in obesity and diabetes. Its progressive form, non-alcoholic steatohepatitis, is a growing indication for liver transplantation in Europe, with good overall outcomes reported. However, careful risk factor assessment is required to maintain favourable post-transplant outcomes in patients with non-alcoholic steatohepatitis.

KEYWORDS:

Aetiology; ELTR database; Long-term follow-up; NAFLD; NASH; Prognosis

PMID:
31071367
DOI:
10.1016/j.jhep.2019.04.011
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