Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.
Laboratory of Hepatology, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium.
Clin Transplant. 2023 Jun;37(6):e14965. doi: 10.1111/ctr.14965. Epub 2023 Mar 20.
Recently, the term metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed to replace non-alcoholic fatty liver disease (NAFLD). This concept enables diagnosing liver disease associated with metabolic dysfunction in patients with alcohol-related liver disease (ALD), a main indication for liver transplantation (LTx). We assessed MAFLD prevalence in ALD patients undergoing LTx and its prognostic value on post-LTx outcomes.
We retrospectively analyzed all ALD patients transplanted at our center between 1990 and August 2020. MAFLD was diagnosed based on the presence or history of hepatic steatosis and a BMI > 25 or type II diabetes or ≥ 2 metabolic risk abnormalities at LTx. Overall survival and risk factors for recurrent liver and cardiovascular events were analyzed by Cox regression.
Of the 371 included patients transplanted for ALD, 255 (68.7%) had concomitant MAFLD at LTx. Median follow-up post-LTx was 72 months (IQR: 34.50-122). Patients with ALD-MAFLD were older at LTx (p = .001), more often male (p < .001) and more frequently had hepatocellular carcinoma (p < .001). No differences in perioperative mortality and overall survival were found. ALD-MAFLD patients had an increased risk of recurrent hepatic steatosis, irrespective of alcohol relapse, but no superimposed risk of cardiovascular events.
The co-presence of MAFLD at LTx for ALD is associated with a distinct patient profile and is an independent risk factor for recurrent hepatic steatosis. The use of MAFLD criteria in ALD patients might increase awareness and treatment of specific hepatic and systemic metabolic abnormalities before and after LTx.
最近，代谢相关脂肪性肝病（MAFLD）这一术语被提出以取代非酒精性脂肪性肝病（NAFLD）。这一概念使人们能够诊断出酒精性肝病（ALD）患者中与代谢功能障碍相关的肝病，ALD 是肝移植（LTx）的主要适应证。我们评估了在接受 LTx 的 ALD 患者中 MAFLD 的患病率及其对 LTx 后结局的预后价值。
我们回顾性分析了 1990 年至 2020 年 8 月期间在我们中心接受 LTx 的所有 ALD 患者。MAFLD 的诊断依据是 LTx 时存在或既往存在肝脂肪变性和 BMI＞25 或 2 型糖尿病或≥2 种代谢风险异常。采用 Cox 回归分析总生存率和复发性肝及心血管事件的危险因素。
在 371 例因 ALD 接受 LTx 的患者中，255 例（68.7%）在 LTx 时同时患有 MAFLD。LTx 后中位随访时间为 72 个月（IQR：34.50-122）。ALD-MAFLD 患者 LTx 时年龄较大（p =.001），男性更常见（p＜.001），且更常患有肝细胞癌（p＜.001）。围手术期死亡率和总生存率无差异。ALD-MAFLD 患者无论是否发生酒精复发，均有发生复发性肝脂肪变性的风险增加，但无叠加的心血管事件风险。
ALD 患者在 LTx 时同时存在 MAFLD 与特定的患者特征相关，是复发性肝脂肪变性的独立危险因素。在 ALD 患者中使用 MAFLD 标准可能会增加对 LTx 前后特定肝脏和全身代谢异常的认识和治疗。
