Department of Gastroenterology, Verona University Hospital, 37124 Verona, Italy.
Multivisceral Transplant Unit, Department of Gastroenterology, Padua University Hospital, 35100 Padua, Italy.
Medicina (Kaunas). 2022 Feb 14;58(2):290. doi: 10.3390/medicina58020290.
: Non-alcoholic steatohepatitis (NASH) has become the leading indication for liver transplantation in many countries, with a growing rate in the Western world. NASH patients are older and share a higher risk of comorbidities and cancer than patients with viral and/or alcoholic etiologies. The aims of this study were to evaluate waiting list (WL) registration and liver transplantation rates in patients with NASH-related cirrhosis at Padua University Hospital in the last fifteen years (1.2006-6.2020) and to compare clinical characteristics and indications for liver transplantation between patients with and without NASH, as well as the WL survival and post-transplant outcome. : All adult patients with cirrhosis listed for liver transplantation at Padua University Hospital between 1.2006 and 6.2020 were retrospectively collected using a prospectively updated database; patients with NASH-related cirrhosis were divided by indication for liver transplantation (Dec-NASH vs. hepatocellular carcinoma (HCC)-NASH) and compared with patients with other etiologies of liver disease. The outcomes in terms of waiting list survival and post-transplant outcome were assessed. : One thousand four hundred and ninety-one adult cirrhotic patients were waitlisted during the study period. NASH patients accounted for 12% of all WL registrations, showing an increasing trend over time (from 2.5% in 2006 to 23% in 2020). In the last five years, NASH was the third, but most rapidly growing, indication for liver transplantation at our center. This trend was confirmed both for patients with decompensated cirrhosis (from 1.8% to 18%) and HCC as leading indication for transplantation (from 4% to 30%). NASH patients were older than non-NASH ones (mean ± SD age 59 ± 9 vs. 56 ± 9 years; < 0.01), whereas no difference was found in gender or Child-Pugh of the model for end-stage liver disease score at WL registration. A majority (60.9%) of NASH patients underwent liver transplantation, showing 1-, 5- and 10-y post-transplant survivals of 86%, 73% and 60%, respectively. : NASH cirrhosis has become a rapidly growing indication for liver transplantation at our center, both for HCC and decompensated disease, with good post-transplant survival.
非酒精性脂肪性肝炎（NASH）已成为许多国家肝移植的主要适应证，在西方国家其发病率呈上升趋势。NASH 患者年龄较大，与病毒性和/或酒精性病因患者相比，合并症和癌症的风险更高。本研究的目的是评估过去十五年（2006 年 1 月至 2020 年 6 月）在帕多瓦大学医院因 NASH 相关肝硬化而登记在等候名单（WL）上和接受肝移植的患者比例，并比较 NASH 患者和非 NASH 患者的临床特征和肝移植适应证，以及 WL 生存率和移植后结局。
使用前瞻性更新的数据库回顾性收集了 2006 年 1 月至 2020 年 6 月期间在帕多瓦大学医院因肝硬化而登记在 WL 上的所有成年患者；根据肝移植的适应证（NASH 相关肝硬化 vs. 肝细胞癌[NASH-HCC]相关肝硬化）将 NASH 相关肝硬化患者进行分组，并与其他病因的肝病患者进行比较。评估了等待名单生存率和移植后结局方面的结果。
在研究期间，共有 1491 名成年肝硬化患者登记在 WL 上。NASH 患者占所有 WL 登记患者的 12%，呈逐年上升趋势（从 2006 年的 2.5%上升到 2020 年的 23%）。在过去五年中，NASH 是我院第三大肝移植适应证，但增长速度最快。这种趋势在失代偿性肝硬化患者（从 1.8%上升至 18%）和作为移植主要适应证的 HCC 患者中都得到了证实（从 4%上升至 30%）。NASH 患者比非 NASH 患者年龄更大（平均±标准差年龄 59±9 岁 vs. 56±9 岁；<0.01），但在 WL 登记时的终末期肝病模型评分的性别或 Child-Pugh 方面无差异。大多数（60.9%）NASH 患者接受了肝移植，其 1、5 和 10 年移植后生存率分别为 86%、73%和 60%。
NASH 肝硬化已成为我院肝移植的一个快速增长的适应证，无论是 HCC 还是失代偿性疾病，移植后生存良好。
