Department of Medicine, Division of Gastroenterology, Veterans Affairs Puget Sound Health Care System and University of Washington, 1959 N.E. Pacific Street, Seattle, WA 98195, USA.
Liver Transpl. 2012 Jan;18(1):29-37. doi: 10.1002/lt.22435.
Because of the ongoing epidemics of obesity and diabetes, nonalcoholic steatohepatitis (NASH) may become a leading indication for liver transplantation. There are concerns about the posttransplant survival of patients with NASH because of associated cardiovascular and metabolic risk factors. We aimed to determine recent trends in the proportion of patients undergoing transplantation for NASH-related cirrhosis in the United States and to estimate their posttransplant survival. We used data provided by the United Network for Organ Sharing for first-time adult cadaveric liver transplants performed in the United States between January 1, 1997 and October 31, 2010 (n = 53,738). The proportion of liver transplants performed for NASH-related cirrhosis increased dramatically from 1.2% in 1997-2003 to 7.4% in 2010 when NASH was the fourth most common indication for transplantation. The posttransplant survival of patients with NASH (n = 1810) at 1 (87.6%), 3 (82.2%), and 5 years (76.7%) was superior to the survival of patients with hepatocellular carcinoma, hepatitis C virus, alcoholic liver disease, acute hepatic necrosis, hemochromatosis, or cryptogenic liver disease and was inferior to the survival of only 4 groups of patients (those with primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune hepatitis, or hepatitis B virus). In conclusion, NASH-related cirrhosis is increasing rapidly as an indication for liver transplantation in the United States and is associated with excellent posttransplant survival.
由于肥胖症和糖尿病的持续流行，非酒精性脂肪性肝炎（NASH）可能成为肝移植的主要适应证。由于与心血管和代谢危险因素相关，人们对 NASH 患者的移植后存活率存在担忧。我们旨在确定美国因 NASH 相关肝硬化而行肝移植患者的比例近期趋势，并评估其移植后的存活率。我们使用了美国器官共享联合网络提供的数据，这些数据是在美国 1997 年 1 月 1 日至 2010 年 10 月 31 日期间进行的首次成人尸体肝移植（n = 53738）。因 NASH 相关肝硬化而行肝移植的比例从 1997-2003 年的 1.2%急剧增加到 2010 年的 7.4%，当时 NASH 是第四大移植适应证。NASH（n = 1810）患者的移植后 1 年（87.6%）、3 年（82.2%）和 5 年（76.7%）的存活率优于肝细胞癌、丙型肝炎病毒、酒精性肝病、急性肝坏死、血色病或特发性肝疾病患者的存活率，仅劣于 4 组患者（原发性胆汁性肝硬化、原发性硬化性胆管炎、自身免疫性肝炎或乙型肝炎病毒）。总之，NASH 相关肝硬化在美国作为肝移植适应证的比例迅速增加，并且与优异的移植后存活率相关。
