Liver Transplantation and Hepatology Unit, La Fe University Hospital, Valencia, Spain.
Liver Transplantation and Hepatology Unit, La Fe University Hospital, Valencia, Spain; Networked Biomedical Research Center oh Hepatic and Digestive Diseases, CIBERehd, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
Ann Hepatol. 2019 Nov-Dec;18(6):855-861. doi: 10.1016/j.aohep.2019.06.014. Epub 2019 Sep 6.
Non-alcoholic steatohepatitis (NASH) indication of liver transplant (LT) has increased recently, whereas alcoholic cirrhosis remains a major indication for LT. To characterize NASH-related cases and to compare the post-transplant outcome of these two conditions represents our major objective.
Patients undergoing LT for NASH between 1997 and 2016 were retrieved. Those transplanted between 1997 and 2006 were compared to an "age and LT date" matched group of patients transplanted for alcoholic cirrhosis (ratio 1:2). Baseline features and medium-term outcome measures were compared.
Of 1986 LT performed between 1997 and 2016, 40 (2%) were labeled as NASH-related indications. NASH-related cases increased initially (from 0.8% in 1997-2001 to 2.7% in 2002-2006) but remained stable in subsequent years (2.3%). Hepatocellular carcinoma (HCC) prevalence was greater in NASH-vs alcohol-related cirrhosis (40% vs 3%, p=0.001). The incidence of overweight, obesity, arterial hypertension, dyslipidemia, diabetes, hyperuricemia, renal insufficiency and cardiovascular (CV) disease was similar in both groups at 5 years post-LT. Five-year survival was higher in NASH but without reaching statistical significance (83% vs 72%, p=0.21). The main cause of mortality in NASH-LT patients was HCC recurrence.
Most previously considered cryptogenic cases are actually NASH-cirrhosis. While the incidence of this indication is increasing in many countries, it has remained relatively stable in our Unit, the largest LT center in Spain. HCC is common in these patients and represents a main cause of post-transplant mortality. Metabolic complications, CV-related disease and 5-yr survival do not differ in patients transplanted for NASH vs alcohol.
非酒精性脂肪性肝炎（NASH）作为肝移植（LT）的适应证近年来有所增加，而酒精性肝硬化仍然是 LT 的主要适应证。本研究旨在对 NASH 相关病例进行特征分析，并比较这两种情况的移植后结果。
检索了 1997 年至 2016 年期间因 NASH 接受 LT 的患者。将 1997 年至 2006 年期间接受 LT 的患者与接受酒精性肝硬化 LT 的“年龄和 LT 日期”匹配的患者（比例为 1:2）进行比较。比较了两组患者的基线特征和中期预后指标。
在 1997 年至 2016 年期间进行的 1986 例 LT 中，有 40 例（2%）被标记为 NASH 相关适应证。NASH 相关病例最初有所增加（从 1997-2001 年的 0.8%增加到 2002-2006 年的 2.7%），但随后几年保持稳定（2.3%）。HCC 在 NASH 相关肝硬化患者中的发生率高于酒精性肝硬化患者（40% vs 3%，p=0.001）。在 LT 后 5 年时，两组患者超重、肥胖、动脉高血压、血脂异常、糖尿病、高尿酸血症、肾功能不全和心血管（CV）疾病的发生率相似。NASH 患者的 5 年生存率较高，但无统计学意义（83% vs 72%，p=0.21）。NASH-LT 患者死亡的主要原因是 HCC 复发。
大多数先前被认为是隐匿性病因的病例实际上是 NASH 肝硬化。虽然这一适应证在许多国家的发病率都在增加，但在我们的单位（西班牙最大的 LT 中心），其发病率相对稳定。这些患者中 HCC 很常见，是移植后死亡的主要原因。代谢并发症、CV 相关疾病和 5 年生存率在接受 NASH 与酒精性肝硬化 LT 的患者中无差异。
