Outcome After Liver Transplantation for NASH Cirrhosis
Outcome After Liver Transplantation for NASH Cirrhosis
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DOI：
10.1111/j.1600-6143.2009.02590.x
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发表时间：
2009-04-01
影响因子：
8.8
通讯作者：
Ahmad, J.
中科院分区：
文献类型：
--
作者：
Malik, S. M.;deVera, M. E.;Ahmad, J.
非酒精性脂肪性肝炎（NASH）相关肝硬化是肝移植（LT）的适应症。本研究的目的是确定NASH肝硬化LT后的结局和不良预测因素。我们分析了1997年至2008年在一个中心接受LT的患者。组织病理学诊断为NASH。以患有丙型肝炎、酒精性或胆汁淤积性肝病和隐源性肝硬化的肝移植受者作为匹配对照。98例肝移植受者被鉴定为NASH肝硬化。与对照组相比，NASH患者的BMI更高（平均32.3 kg/m2），更可能患有糖尿病和高血压。NASH患者和对照组移植后死亡率相似，但NASH患者早期死亡率有较高的趋势（30天死亡率6.1%，1年死亡率21.4%）。脓毒症占NASH患者所有死亡的一半，显著高于对照组。NASH患者年龄≥ 60岁，BMI ≥ 30 kg/m2，合并糖尿病和高血压（HTN），1年死亡率为50%。总之，因NASH肝硬化接受LT的患者与因其他适应症接受LT的患者结局相似。高龄、高BMI、糖尿病和HTN的组合与LT后的不良结局相关。在向这些高危患者提供LT之前，需要仔细考虑。
Nonalcoholic steatohepatitis (NASH) associated cirrhosis is an increasing indication for liver transplant (LT). The aim of this study was to determine outcome and poor predictive factors after LT for NASH cirrhosis. We analyzed patients undergoing LT from 1997 to 2008 at a single center. NASH was diagnosed on histopathology. LT recipients with hepatitis C, alcoholic or cholestatic liver disease and cryptogenic cirrhosis acted as matched controls.Ninety-eight LT recipients were identified with NASH cirrhosis. Compared to controls, NASH patients had a higher BMI (mean 32.3 kg/m(2)), and were more likely to be diabetic and hypertensive. Mortality after transplant was similar between NASH patients and controls but there was a tendency for higher earlier mortality in NASH patients (30-day mortality 6.1%, 1-year mortality 21.4%). Sepsis accounted for half of all deaths in NASH patients, significantly higher than controls. NASH patients >= 60 years, BMI >= 30 kg/m(2) with diabetes and hypertension (HTN) had a 50% 1-year mortality.In conclusion, patients undergoing LT for NASH cirrhosis have a similar outcome to patients undergoing LT for other indications. The combination of older age, higher BMI, diabetes and HTN are associated with poor outcome after LT. Careful consideration is warranted before offering LT to these high-risk patients.