Doycheva Iliana, Issa Danny, Watt Kymberly D, Lopez Rocio, Rifai Ghassoub, Alkhouri Naim
Division of Gastroenterology and Hepatology, Medical University, Sofia, Bulgaria.
Division of Gastroenterology, Virginia Commonwealth University, Richmond, VA.
J Clin Gastroenterol. 2018 Apr;52(4):339-346. doi: 10.1097/MCG.0000000000000925.
To analyze the frequency and trend of liver transplantation (LT) for nonalcoholic steatohepatitis (NASH) cirrhosis in young adults aged 18 to 40 years and to assess post-LT outcomes in this age group.
NASH is currently the fastest-growing indication for LT in US adults. It is believed that NASH is a rare indication for LT among young adults.
Using the United Network for Organ Sharing database, we performed a retrospective cohort analysis of all LTs in young adults between 2002 and 2012. Incidence rate ratio was calculated for each indication.
A total of 5157 young adults underwent LT over the study period-54% were male, 23% obese. Mean (±SD) age and body mass index were 31.6±6.7 years and 26.3±6.1 kg/m, respectively. The incidence of LTs performed for NASH cirrhosis increased from 0.53% in 2002 to 4.46% in 2012. NASH was the most rapidly growing indication for LT among all other etiologies with a 14% increment per year (incidence rate ratio, 1.14; 95% confidence interval, 1.09-1.20, P<0.001). The 5-year post-LT outcomes were comparable between NASH and non-NASH recipients, but graft survival was lower and retransplantation cumulative rates were higher in NASH recipients compared with those with other metabolic liver diseases (63.5% vs. 81.4%, P=0.003 and 12.7% vs. 4.2%, P=0.046, respectively).
NASH is the fastest-growing indication for LT among young US adults aged 18 to 40 years and now accounts for almost 5% of all LTs in this age group.
分析18至40岁年轻成年人中因非酒精性脂肪性肝炎（NASH）肝硬化进行肝移植（LT）的频率和趋势，并评估该年龄组肝移植后的结局。
NASH目前是美国成年人中肝移植增长最快的适应证。据信，NASH在年轻成年人中是肝移植的罕见适应证。
利用器官共享联合网络数据库，我们对2002年至2012年间年轻成年人的所有肝移植进行了回顾性队列分析。计算每种适应证的发病率比。
在研究期间，共有5157名年轻成年人接受了肝移植，其中54%为男性，23%为肥胖者。平均（±标准差）年龄和体重指数分别为31.6±6.7岁和26.3±6.1kg/m²。因NASH肝硬化进行的肝移植发生率从2002年的0.53%增至2012年的4.46%。在所有其他病因中，NASH是肝移植增长最快的适应证，每年增长14%（发病率比，1.14；95%置信区间，1.09-1.20，P<0.001）。NASH受者和非NASH受者肝移植后5年的结局相当，但与其他代谢性肝病受者相比，NASH受者的移植物存活率较低，再次移植累积率较高（分别为63.5%对81.4%，P=0.003和12.7%对4.2%，P=0.046）。
NASH是美国18至40岁年轻成年人中肝移植增长最快的适应证，目前占该年龄组所有肝移植的近5%。
