肝移植治疗非酒精性脂肪性肝炎：新的流行疾病。

Liver transplantation for nonalcoholic steatohepatitis: the new epidemic.

机构信息

Dumont-UCLA Transplant and Liver Cancer Centers, Pfleger Liver Institute, Department of Surgery, Los Angeles, CA, USA.

出版信息

Ann Surg. 2012 Oct;256(4):624-33. doi: 10.1097/SLA.0b013e31826b4b7e.

DOI:10.1097/SLA.0b013e31826b4b7e

PMID:22964732

Abstract

OBJECTIVE

To analyze incidence, outcomes, and utilization of health care resources in liver transplantation (LT) for nonalcoholic steatohepatitis (NASH).

SUMMARY OF BACKGROUND DATA

With the epidemic of obesity and metabolic syndrome in nearly 33% of the US population, NASH is projected to become the leading indication for LT in the next several years. Data on predictors of outcome and utilization of health care resources after LT in NASH is limited.

METHODS

We conducted an analysis from our prospective database of 144 adult NASH patients who underwent LT between December 1993 and August 2011. Outcomes and resource utilization were compared with other common indications for LT. Independent predictors of graft and patient survival were identified.

RESULTS

The average Model for End-Stage Liver Disease score was 33. The frequency of NASH as the primary indication for LT increased from 3% in 2002 to 19% in 2011 to become the second most common indication for LT at our center behind hepatitis C. NASH patients had significantly longer operative times (402 vs 322 minutes; P < 0.001), operative blood loss (18 vs 14 packed red blood cell units; P = 0.001), and posttransplant length of stay (35 vs 29 days; P = 0.032), but 1-, 3-, and 5-year graft (81%, 71%, 63%) and patient (84%, 75%, 70%) survival were comparable with other diagnoses. Age greater than 55 years, pretransplant intubation, dialysis, hospitalization, presence of hepatocellular carcinoma on explant, donor age greater than 55 years, and cold ischemia time greater than 550 minutes were significant independent predictors of survival for all patients, whereas body mass index greater than 35 was a predictor in NASH patients only.

CONCLUSIONS

We report the largest single institution experience of LT for NASH. Over a 10-year period, the frequency of LT for NASH has increased 5-fold. Although outcomes are comparable with LT for other indications, health care resources are stressed significantly by this new and increasing group of transplant candidates.

摘要

目的

分析非酒精性脂肪性肝炎（NASH）患者行肝移植（LT）的发病率、结局和医疗资源利用情况。

摘要背景数据

由于美国近 33%的人口肥胖和代谢综合征流行，预计 NASH 将在未来几年成为 LT 的主要适应证。关于 NASH 患者 LT 后结局和医疗资源利用情况的数据有限。

方法

我们对 1993 年 12 月至 2011 年 8 月期间在我院接受 LT 的 144 例成年 NASH 患者的前瞻性数据库进行了分析。比较了这些患者与其他常见 LT 适应证的结局和资源利用情况。确定了移植物和患者生存的独立预测因素。

结果

平均终末期肝病模型评分（Model for End-Stage Liver Disease score）为 33。NASH 作为 LT 主要适应证的频率从 2002 年的 3%增加到 2011 年的 19%，成为我院继丙型肝炎之后的第二大 LT 适应证。NASH 患者的手术时间（402 分钟比 322 分钟；P < 0.001）、手术失血量（18 个单位比 14 个单位红细胞；P = 0.001）和术后住院时间（35 天比 29 天；P = 0.032）均显著延长，但 1、3、5 年移植物（81%、71%、63%）和患者（84%、75%、70%）存活率与其他诊断无差异。大于 55 岁、术前插管、透析、住院、肝移植标本中存在肝细胞癌、供者年龄大于 55 岁和冷缺血时间大于 550 分钟是所有患者生存的独立显著预测因素，而 BMI 大于 35 是 NASH 患者的独立预测因素。