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

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...

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Autores principales: Haldar, Debashis, Kern, Barbara, Hodson, James, Armstrong, Matthew James, Adam, Rene, Berlakovich, Gabriela, Fritz, Josef, Feurstein, Benedikt, Popp, Wolfgang, Karam, Vincent, Muiesan, Paolo, O'Grady, John, Jamieson, Neville, Wigmore, Stephen J., Pirenne, Jacques, Malek-Hosseini, Seyed Ali, Hidalgo, Ernest, Tokat, Yaman, Paul, Andreas, Pratschke, Johann, Bartels, Michael, Trunecka, Pavel, Settmacher, Utz, Pinzani, Massimo, Duvoux, Christophe, Newsome, Philip Noel, Schneeberger, Stefan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6656693/
https://www.ncbi.nlm.nih.gov/pubmed/31071367
http://dx.doi.org/10.1016/j.jhep.2019.04.011
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author Haldar, Debashis
Kern, Barbara
Hodson, James
Armstrong, Matthew James
Adam, Rene
Berlakovich, Gabriela
Fritz, Josef
Feurstein, Benedikt
Popp, Wolfgang
Karam, Vincent
Muiesan, Paolo
O'Grady, John
Jamieson, Neville
Wigmore, Stephen J.
Pirenne, Jacques
Malek-Hosseini, Seyed Ali
Hidalgo, Ernest
Tokat, Yaman
Paul, Andreas
Pratschke, Johann
Bartels, Michael
Trunecka, Pavel
Settmacher, Utz
Pinzani, Massimo
Duvoux, Christophe
Newsome, Philip Noel
Schneeberger, Stefan
author_facet Haldar, Debashis
Kern, Barbara
Hodson, James
Armstrong, Matthew James
Adam, Rene
Berlakovich, Gabriela
Fritz, Josef
Feurstein, Benedikt
Popp, Wolfgang
Karam, Vincent
Muiesan, Paolo
O'Grady, John
Jamieson, Neville
Wigmore, Stephen J.
Pirenne, Jacques
Malek-Hosseini, Seyed Ali
Hidalgo, Ernest
Tokat, Yaman
Paul, Andreas
Pratschke, Johann
Bartels, Michael
Trunecka, Pavel
Settmacher, Utz
Pinzani, Massimo
Duvoux, Christophe
Newsome, Philip Noel
Schneeberger, Stefan
author_sort Haldar, Debashis
collection PubMed
description 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/m(2): HR 4.29, p = 0.048) or high (>40 kg/m(2): 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.
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spelling pubmed-66566932019-08-01 Outcomes of liver transplantation for non-alcoholic steatohepatitis: A European Liver Transplant Registry study Haldar, Debashis Kern, Barbara Hodson, James Armstrong, Matthew James Adam, Rene Berlakovich, Gabriela Fritz, Josef Feurstein, Benedikt Popp, Wolfgang Karam, Vincent Muiesan, Paolo O'Grady, John Jamieson, Neville Wigmore, Stephen J. Pirenne, Jacques Malek-Hosseini, Seyed Ali Hidalgo, Ernest Tokat, Yaman Paul, Andreas Pratschke, Johann Bartels, Michael Trunecka, Pavel Settmacher, Utz Pinzani, Massimo Duvoux, Christophe Newsome, Philip Noel Schneeberger, Stefan J Hepatol Article 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/m(2): HR 4.29, p = 0.048) or high (>40 kg/m(2): 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. Elsevier 2019-08 /pmc/articles/PMC6656693/ /pubmed/31071367 http://dx.doi.org/10.1016/j.jhep.2019.04.011 Text en © 2019 European Association for the Study of the Liver. Elsevier B.V. All rights reserved. http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Haldar, Debashis
Kern, Barbara
Hodson, James
Armstrong, Matthew James
Adam, Rene
Berlakovich, Gabriela
Fritz, Josef
Feurstein, Benedikt
Popp, Wolfgang
Karam, Vincent
Muiesan, Paolo
O'Grady, John
Jamieson, Neville
Wigmore, Stephen J.
Pirenne, Jacques
Malek-Hosseini, Seyed Ali
Hidalgo, Ernest
Tokat, Yaman
Paul, Andreas
Pratschke, Johann
Bartels, Michael
Trunecka, Pavel
Settmacher, Utz
Pinzani, Massimo
Duvoux, Christophe
Newsome, Philip Noel
Schneeberger, Stefan
Outcomes of liver transplantation for non-alcoholic steatohepatitis: A European Liver Transplant Registry study
title Outcomes of liver transplantation for non-alcoholic steatohepatitis: A European Liver Transplant Registry study
title_full Outcomes of liver transplantation for non-alcoholic steatohepatitis: A European Liver Transplant Registry study
title_fullStr Outcomes of liver transplantation for non-alcoholic steatohepatitis: A European Liver Transplant Registry study
title_full_unstemmed Outcomes of liver transplantation for non-alcoholic steatohepatitis: A European Liver Transplant Registry study
title_short Outcomes of liver transplantation for non-alcoholic steatohepatitis: A European Liver Transplant Registry study
title_sort outcomes of liver transplantation for non-alcoholic steatohepatitis: a european liver transplant registry study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6656693/
https://www.ncbi.nlm.nih.gov/pubmed/31071367
http://dx.doi.org/10.1016/j.jhep.2019.04.011
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