Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
Clin Transplant. 2022 Aug;36(8):e14714. doi: 10.1111/ctr.14714. Epub 2022 Jun 2.
Nonalcoholic steatohepatitis (NASH) is associated with metabolic conditions that increase the risk of de novo malignancy following transplant. Patients often have more than one underlying liver disease, which could change the risk of de novo malignancy. This study assessed the incidence of NASH overlap and its effect on de novo malignancy in liver transplant recipients.
Data was analyzed from the United Network for Organ Sharing database for all liver transplant recipients from 1997 to 2017 for NASH alone or in combination with another liver disease.
There is an increasing prevalence of NASH overlap. Of the 98,679 patients included in the analysis, 1238 had a de novo malignancy identified (7.4% by 5 years post-transplant). The cumulative incidence of de novo malignancy increases in primary sclerosing cholangitis (PSC)/NASH overlap after 5 years and was increased in alcohol-related liver disease (ALD)/NASH through 10 years compared to ether disease alone. NASH overlaps with "other" diseases experience a cumulative incidence similar to NASH and not the "other" disease. An increased risk of de novo solid organ malignancy was associated with older age, male gender, previous malignancy, and multiorgan transplant.
The prevalence of liver transplant recipients with NASH overlap is increasing. These patients may experience different long-term outcomes than patients with either diagnosis alone. De novo malignancy risk can be influenced by multiple factors and metabolic comorbidities. Further study of patients with overlap diagnoses is important moving forward to guide individualized care and cancer screening programs.
非酒精性脂肪性肝炎（NASH）与增加移植后新发恶性肿瘤风险的代谢疾病有关。患者通常患有一种以上的基础肝病，这可能会改变新发恶性肿瘤的风险。本研究评估了肝移植受者中 NASH 重叠的发生率及其对新发恶性肿瘤的影响。
对 1997 年至 2017 年期间来自美国器官共享网络（UNOS）数据库的所有肝移植受者中单独发生 NASH 或与其他肝病并存的 NASH 数据进行了分析。
NASH 重叠的患病率呈上升趋势。在纳入分析的 98679 例患者中，有 1238 例患者被发现新发恶性肿瘤（移植后 5 年内为 7.4%）。原发性硬化性胆管炎（PSC）/NASH 重叠患者的新发恶性肿瘤累积发生率在 5 年后增加，而酒精性肝病（ALD）/NASH 患者在 10 年内的发生率高于其他疾病。NASH 与“其他”疾病重叠的患者的累积发病率与 NASH 相似，而不是与“其他”疾病相似。新发实体器官恶性肿瘤的风险增加与年龄较大、男性、既往恶性肿瘤和多器官移植有关。
NASH 重叠的肝移植受者的患病率正在增加。这些患者的长期预后可能与单独诊断为任何一种疾病的患者不同。新发恶性肿瘤的风险可能受到多种因素和代谢合并症的影响。进一步研究重叠诊断患者对于指导个体化治疗和癌症筛查计划具有重要意义。
