Center for Liver Diseases, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
Liver Transpl. 2009 Dec;15(12):1814-20. doi: 10.1002/lt.21927.
Nonalcoholic steatohepatitis (NASH) is becoming a common cause of liver cirrhosis requiring liver transplantation (LT). Cardiovascular complications related to metabolic syndrome and NASH recurrence in the transplanted liver may affect the outcome of LT in these patients. We compared the outcomes of LT for NASH cirrhosis and alcoholic cirrhosis (ETOH) in a large transplant center. A retrospective chart review was performed for all patients who underwent LT for cryptogenic cirrhosis with the NASH phenotype (the NASH group) or ETOH (the ETOH group) at the University of Miami from January 1997 to January 2007. There was no significant difference in survival between the NASH and ETOH groups, despite a trend toward lower survival in the former (P = 0.1699). Sepsis was the leading cause of posttransplant death in both groups, and it was followed by cardiovascular causes in the NASH group (26% versus 7% in the ETOH group, P = 0.21) and malignancies in the ETOH group (29% versus 0% in the NASH group, P = 0.024). Recurrent steatohepatitis (33% versus 0%, P < 0.0001) and acute rejection (41% versus 23%, P < 0.023) were significantly more frequent in the NASH group than in the ETOH group. There was no difference in graft failure between the groups (24% in the NASH group versus 18% in the ETOH group, P = 0.3973). In conclusion, despite a numerical trend favoring the ETOH group, there were no statistically significant differences in posttransplant survival and cardiovascular mortality between the NASH and ETOH groups. Acute rejection and recurrent steatohepatitis were significantly more frequent in the NASH group but did not lead to higher rates of retransplantation.
非酒精性脂肪性肝炎（NASH）正在成为导致需要进行肝移植（LT）的肝硬化的常见原因。与代谢综合征相关的心血管并发症和移植肝脏中 NASH 的复发可能会影响这些患者的 LT 结局。我们比较了在一个大型移植中心，NASH 肝硬化和酒精性肝硬化（ETOH）患者进行 LT 的结局。对 1997 年 1 月至 2007 年 1 月期间，在迈阿密大学因隐匿性肝硬化且具有 NASH 表型（NASH 组）或 ETOH（ETOH 组）而接受 LT 的所有患者进行了回顾性图表审查。尽管前者的存活率呈下降趋势，但 NASH 和 ETOH 两组之间的存活率无显著差异（P=0.1699）。两组患者中，移植后死亡的主要原因均为败血症，随后 NASH 组为心血管原因（26%对 ETOH 组的 7%，P=0.21），ETOH 组为恶性肿瘤（29%对 NASH 组的 0%，P=0.024）。NASH 组的复发性脂肪性肝炎（33%对 0%，P<0.0001）和急性排斥反应（41%对 23%，P<0.023）的发生率显著高于 ETOH 组。两组之间的移植物失败无差异（NASH 组 24%，ETOH 组 18%，P=0.3973）。总之，尽管 ETOH 组有数字趋势，但在移植后存活率和心血管死亡率方面，NASH 和 ETOH 两组之间无统计学差异。NASH 组的急性排斥反应和复发性脂肪性肝炎发生率显著较高，但并未导致更高的再次移植率。
