Long-term Outcomes in Patients Undergoing Liver Transplantation for Nonalcoholic Steatohepatitis-Related Cirrhosis
Long-term Outcomes in Patients Undergoing Liver Transplantation for Nonalcoholic Steatohepatitis-Related Cirrhosis
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DOI：
10.1097/tp.0000000000001709
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发表时间：
2017-08-01
期刊：
影响因子：
6.2
通讯作者：
Siddiqui, Mohammad Shadab
中科院分区：
文献类型：
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作者：
Bhati, Chandra;Idowu, Michael O.;Siddiqui, Mohammad Shadab
背景 非酒精性脂肪性肝炎 (NASH) 是非酒精性脂肪性肝病 (NAFLD) 的一种临床侵袭性变体，正成为肝移植 (LT) 越来越常见的适应症。然而，对其 LT 后的临床病程知之甚少。本研究的目的是描述 LT 后的疾病复发和临床病程。 方法 对作者所在机构因 NASH 移植的所有存活患者进行瞬时弹性成像 (TE) 来评估肝脂肪变性和纤维化。对已故患者的病历进行肝活检检查，以评估疾病复发情况。最后，对这些患者的死亡原因进行了评估。结果 在符合标准的 103 例患者中，56 例进行了 TE，34 例进行了肝活检。 49 名 (87.5%) 的 TE 患者检测到脂肪变性，并被定义为复发性 NAFLD。大多数患者的肝脏硬度测量结果与无纤维化（42.9%）或 F1-F2 纤维化（30.4%）一致。 26.8% 的人患有晚期纤维化，而 5.4% 的人患有肝硬化，但得到了临床补偿。在接受肝活检的患者中，88.2% 的患者复发 NAFLD，而 41.2% 的患者复发 NASH。 20.6% 的患者出现桥接纤维化，但没有患者出现肝硬化。在该队列中，32 名患者死于癌症 (25%)、感染性并发症 (25%) 和心血管疾病 (21.9%) 的主要原因。只有 9% 的死亡可归因于移植肝硬化。结论 复发性 NAFLD 是 LT 后常见的常见疾病，发生在近 88% 的患者中，而近四分之一的患者患有晚期纤维化。
Background Nonalcoholic steatohepatitis (NASH), a clinically aggressive variant of nonalcoholic fatty liver disease (NAFLD), is becoming an increasingly common indication for liver transplantation (LT); however, relatively little is known regarding its clinical course post-LT. The aim of the current study is to describe disease recurrence and clinical course after LT.Methods All surviving patients transplanted for NASH at the authors' institution had transient elastography (TE) to evaluate hepatic steatosis and fibrosis. The charts of deceased patients were reviewed for liver biopsy to evaluate for disease recurrence. Finally, causes of mortality in these patients were evaluated.Results Of the 103 patients who met criteria, 56 had TE, whereas 34 had a liver biopsy. Steatosis was detected in 49 (87.5%) of the patients who had a TE and were defined to have recurrent NAFLD. Most patients had liver stiffness measurements consistent with no fibrosis (42.9%) or F1-F2 fibrosis (30.4%). Advanced fibrosis was noted in 26.8%, whereas 5.4% had cirrhosis but were clinically compensated. In patients with liver biopsy, 88.2% had recurrent NAFLD, whereas 41.2% had recurrent NASH. Bridging fibrosis was noted in 20.6% of patients but no patients had cirrhosis. Within the cohort, 32 patients died with the leading cause of mortality cancer (25%), infectious complications (25%), and cardiovascular disease (21.9%). Only 9% of deaths were attributable to graft cirrhosis.Conclusions Recurrent NAFLD is common post-LT occurring in nearly 88% of all patients, whereas nearly a quarter of patients were noted to have advanced fibrosis.