Increased Risk of Death in First Year After Liver Transplantation Among Patients With Nonalcoholic Steatohepatitis vs Liver Disease of Other Etiologies
Increased Risk of Death in First Year After Liver Transplantation Among Patients With Nonalcoholic Steatohepatitis vs Liver Disease of Other Etiologies
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DOI：
10.1016/j.cgh.2019.04.033
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发表时间：
2019-12-01
影响因子：
12.6
通讯作者：
Moonka, Dilip
中科院分区：
文献类型：
--
作者：
Nagai, Shunji;Collins, Kelly;Moonka, Dilip
背景与目的：越来越多的非酒精性脂肪性肝炎（NASH）患者需要肝种植园。我们比较了不同病因的肝病患者（NASH、丙型肝炎病毒（HCV）相关肝病和酒精相关肝病（ALD））的结局。方法：我们分析了来自器官共享联合网络登记处的6344例因NASH接受肝移植的患者、17,037例因慢性HCV感染肝硬化接受肝移植的患者和9279例因ALD接受肝移植的患者的数据。我们收集了在以下时间段接受肝移植的患者的数据：2008-2010，2011-2013，2014-2015，2016-2017。我们使用考克斯回归模型比较了不同组的结果，调整了供体和受体的特征。结果：对于2016-2017年接受肝移植的患者，NASH患者在移植后1年存活的比例显著低于HCV患者（P = .004）或ALD患者（P < .001）。在此期间，NASH患者1年内校正的死亡风险显著高于ALD患者（风险比，1.37; P = .03），无论是否存在肝细胞癌。年龄增长对NASH患者的影响最大：与年龄小于50岁的患者相比，50-59岁患者的总体死亡率风险比为1.31（P = 0.02），60-64岁患者为1.66（P <0.001），65-69岁患者为2.08（P <0.001），≥ 70岁患者为2.66（P <0.001）。NASH患者的心血管或脑血管疾病死亡率最高，占死亡人数的11.5%，而HCV感染患者的死亡率为7.0%，ALD患者为9.6%结论：在对2016-2017年期间接受肝移植的患者数据的分析中，我们发现NASH患者移植后1年内的死亡风险高于HCV相关肝病或ALD患者。死亡风险随着年龄的增长而增加，NASH患者死于心血管或脑血管疾病的风险更高。
BACKGROUND & AIMS: An increasing number of patients with non-alcoholic steatohepatitis (NASH) require liver trans- plantation. We compared outcomes of patients with liver diseases of different etiologies (NASH, hepatitis C virus [HCV]-associated liver disease, and alcohol-associated liver disease [ALD]).METHODS: We analyzed data from the United Network for Organ Sharing registry on 6344 patients who underwent liver transplantation for NASH, 17,037 for cirrhosis from chronic HCV infection, and 9279 for ALD. We collected data from patients who underwent liver transplantation during the following time periods: 2008-2010, 2011-2013, 2014-2015, 2016-2017. We compared outcomes of different groups using Cox regression models, adjusting for donor and recipient characteristics.RESULTS: For patients who underwent liver transplantation during 2016-2017, a significantly lower proportion of patients with NASH survived for 1 year after transplantation than patients with HCV (P = .004) or ALD (P < .001). During this time period, the adjusted risk of death within 1 year was significantly higher for patients with NASH than with ALD (hazard ratio, 1.37; P = .03), regardless of the presence of hepatocellular carcinoma. The effects of increasing age were greatest among patients with NASH: compared to patients younger than 50 years, hazard ratios for overall mortality were 1.31 for patients 50-59 years (P = .02), 1.66 for patients 60-64 years (P < .001), 2.08 for patients 65-69 years (P < .001), and 2.66 and for patients and >= 70 years (P < .001). Mortality from cardiovascular or cerebrovascular disease(s) was highest among patients with NASH, accounting for 11.5% of deaths, compared to 7.0% of deaths in patients with HCV infection and 9.6% in patients with ALD (P < .001).CONCLUSIONS: In an analysis of data from patients who underwent liver transplantation during 2016-2017, we found the risk of death within 1 year after transplant was higher among patients with NASH than HCV-associated liver disease or ALD. Risk of death increased with age, and patients with NASH have a higher risk of death from cardiovascular or cerebrovascular disease.