Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
Division of Hepatology, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
Liver Int. 2018 Nov;38(11):2082-2090. doi: 10.1111/liv.13751. Epub 2018 May 2.
BACKGROUND & AIMS: Nonalcoholic fatty liver disease(NAFLD) is the second most common cause of liver transplantation in the US. Data on NAFLD as a liver transplantation indication from countries with lower prevalences of obesity are lacking. We studied the temporal trends of NAFLD as an indication for liver transplantation in the Nordic countries, and compared outcomes for patients with NAFLD to patients with other indications for liver transplantation.
Population-based cohort study using data from the Nordic Liver Transplant Registry on adults listed for liver transplantation between 1994 and 2015. NAFLD as the underlying indication for liver transplantation was defined as a listing diagnosis of NAFLD/nonalcoholic steatohepatitis, or cryptogenic cirrhosis with a body mass index ≥25 kg/m and absence of other liver diseases. Waiting time for liver transplantation, mortality and withdrawal from the transplant waiting list were registered. Survival after liver transplantation was calculated using multivariable Cox regression, adjusted for age, sex, body mass index and model for end-stage liver disease.
A total of 4609 patients listed for liver transplantation were included. NAFLD as the underlying indication for liver transplantation increased from 2.0% in 1994-1995 to 6.2% in 2011-2015 (P = .01) and was the second most rapidly increasing indication. NAFLD patients had higher age, model for end-stage liver disease and body mass index when listed for liver transplantation, but overall survival after liver transplantation was comparable to non--NAFLD patients (aHR 1.03, 95% CI 0.70-1.53 P = .87).
NAFLD is an increasing indication for liver transplantation in the Nordic countries. Despite more advanced liver disease, NAFLD patients have a comparable survival to other patients listed for liver transplantation.
非酒精性脂肪性肝病（NAFLD）是美国第二大肝移植原因。肥胖症患病率较低的国家缺乏有关 NAFLD 作为肝移植适应证的数据。我们研究了北欧国家 NAFLD 作为肝移植适应证的时间趋势，并比较了 NAFLD 患者和其他肝移植适应证患者的结局。
利用北欧肝移植登记处 1994 年至 2015 年期间接受肝移植登记的成年人的数据进行基于人群的队列研究。NAFLD 作为肝移植的基础适应证定义为 NAFLD/非酒精性脂肪性肝炎的列诊断，或隐源性肝硬化，伴有 BMI≥25 kg/m2 且无其他肝脏疾病。记录肝移植的等待时间、死亡率和从移植等待名单中撤出。使用多变量 Cox 回归计算肝移植后的生存情况，调整了年龄、性别、BMI 和终末期肝病模型。
共纳入 4609 例接受肝移植的患者。NAFLD 作为肝移植的基础适应证从 1994-1995 年的 2.0%增加到 2011-2015 年的 6.2%（P=.01），是增长第二快的适应证。NAFLD 患者在接受肝移植时年龄更大、终末期肝病模型和 BMI 更高，但肝移植后总体生存率与非-NAFLD 患者相当（aHR 1.03，95%CI 0.70-1.53，P=.87）。
NAFLD 是北欧国家肝移植的一个不断增加的适应证。尽管肝病更严重，但 NAFLD 患者的生存率与其他接受肝移植的患者相当。
