VanWagner Lisa B, Lapin Brittany, Skaro Anton I, Lloyd-Jones Donald M, Rinella Mary E
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Liver Int. 2015 Dec;35(12):2575-83. doi: 10.1111/liv.12872. Epub 2015 Jun 3.
BACKGROUND & AIMS: Non-alcoholic steatohepatitis (NASH) is an independent risk factor for cardiovascular disease (CVD) morbidity after liver transplantation, but its impact on CVD mortality is unknown. We sought to assess the impact of NASH on CVD mortality after liver transplantation and to predict which NASH recipients are at highest risk of a CVD-related death following a liver transplant.
Using the Organ Procurement and Transplantation Network database, we examined associations between NASH and post-liver transplant CVD mortality, defined as primary cause of death from thromboembolism, arrhythmia, heart failure, myocardial infarction or stroke. A physician panel reviewed cause of death.
Of 48 360 liver transplants (2/2002-12/2011), 5057 (10.5%) were performed for NASH cirrhosis. NASH recipients were more likely to be older, female, obese, diabetic and have history of renal failure or prior CVD vs. non-NASH (P < 0.001 for all). Although there was no difference in overall all-cause mortality (log-rank P = 0.96), both early (30-day) and long-term CVD-specific mortality was increased among NASH recipients (Odds ratio = 1.30, 95% Confidence interval (CI): 1.02-1.66; Hazard ratio = 1.42, 95% CI: 1.07-1.41 respectively). These associations were no longer significant after adjustment for pre-transplant diabetes, renal impairment or CVD. A risk score comprising age ≥55, male sex, diabetes and renal impairment was developed for prediction of post-liver transplant CVD mortality (c-statistic 0.60).
NASH recipients have an increased risk of CVD mortality after liver transplantation explained by a high prevalence of comorbid cardiometabolic risk factors that in aggregate identify those at highest risk of post-transplant CVD mortality.
非酒精性脂肪性肝炎（NASH）是肝移植后心血管疾病（CVD）发病的独立危险因素，但其对CVD死亡率的影响尚不清楚。我们旨在评估NASH对肝移植后CVD死亡率的影响，并预测哪些NASH受者在肝移植后发生CVD相关死亡的风险最高。
利用器官获取与移植网络数据库，我们研究了NASH与肝移植后CVD死亡率之间的关联，CVD死亡率定义为血栓栓塞、心律失常、心力衰竭、心肌梗死或中风导致的主要死亡原因。一个医生小组对死亡原因进行了审查。
在48360例肝移植手术（2002年2月至2011年12月）中，5057例（10.5%）因NASH肝硬化进行。与非NASH受者相比，NASH受者更可能年龄较大、为女性、肥胖、患有糖尿病且有肾衰竭或既往CVD病史（所有P<0.001）。虽然总体全因死亡率无差异（对数秩检验P=0.96），但NASH受者的早期（30天）和长期CVD特异性死亡率均升高（优势比=1.30，95%置信区间（CI）：1.02-1.66；风险比分别为1.42，95%CI：1.07-1.41）。在对移植前糖尿病、肾功能损害或CVD进行调整后，这些关联不再显著。开发了一个包括年龄≥≥55岁、男性、糖尿病和肾功能损害的风险评分，用于预测肝移植后CVD死亡率（c统计量0.60）。
NASH受者肝移植后CVD死亡风险增加，这可由合并的心脏代谢危险因素的高患病率来解释，这些因素共同识别出移植后CVD死亡风险最高的人群。
