Patients with Nonalcoholic Liver Disease Qualify for Transplan

Patients with Nonalcoholic Liver Disease Qualify for Transplant
By Kristina Fiore, Staff Writer, MedPage Today
Published: November 25, 2009
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Earn CME/CE credit
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In a retrospective study, there were no significant differences between patients with NASH and those with alcoholic cirrhosis in post-transplant mortality (27% versus 17%, P=0.17) and cardiovascular mortality (26% versus 7%, P=0.21), Vishal Bhagat, MD, of the University of Miami, and colleagues reported in the December issue of Liver Transplantation.

More NASH patients did die from cardiovascular causes than alcoholic cirrhosis patients, although the difference was not statistically significant.

"Cryptogenic cirrhosis with the NASH phenotype is an acceptable indication for liver transplant, with post-transplant survival rates similar to those for other causes of cirrhosis," the researchers concluded.

"Aggressive control of metabolic syndrome may have some role in the post-transplant management of these patients, not only to prevent disease recurrence in the transplanted liver but also to prevent cardiovascular mortality."

Nonalcoholic steatohepatitis is becoming a common cause of liver cirrhosis requiring liver transplantation, the researchers said. Yet prognosis and post-transplant outcomes of NASH cirrhosis have not been well defined.

So investigators conducted a retrospective chart review of all liver transplant patients at the University of Miami from January 1997 to January 2007. There were a total of 1,705 cases, but the researchers focused on 71 patients with NASH and 83 patients with alcoholic cirrhosis.

The researchers said components of metabolic syndrome were significantly more prevalent in the NASH group.

Although there was a trend toward lower survival in the NASH group, it was not statistically significant. One-, three-, five-, and nine-year patient survival probabilities were 82%, 79%, 75%, and 62% in the NASH group and 92%, 86%, 86%, and 76% in the alcoholic cirrhosis group.

Sepsis was the leading cause of post-transplant death in both groups, followed by cardiovascular causes in the NASH group and malignancies in the alcoholic cirrhosis group.

A higher number of patients died from cardiovascular causes in the NASH group than in the alcoholic cirrhosis group. Although the difference wasn't statistically significant, they noted, "cardiovascular mortality in our NASH group was much higher than that based on published autopsy results for liver transplant patients."

While there was no difference in graft failure between the two groups, acute rejection and recurrent steatohepatitis were significantly more frequent in the NASH group.

More patients in the NASH group had biopsy-proven acute rejection (41% versus 23%, P=0.023).

And no patients in the alcoholic cirrhosis group had disease recurrence, but 33% of patients in the NASH group showed moderate to severe recurrence of steatohepatitis in liver biopsy specimens.

Yet these findings did not lead to higher rates of retransplantation, the researchers said.

"Although there were higher rates of acute rejections and recurrent steatohepatitis in the NASH group, graft survival and retransplantation rates were not different," they concluded. "We have shown that NASH cirrhosis is an acceptable indication for liver transplantation, with graft and patient survival rates comparable to those for other causes of cirrhosis."

They noted that the study was limited by: its retrospective design, a relatively small number of patients, the definition of NASH based on clinical parameters of metabolic syndrome, and absence of data on immunosuppressive regimens and post-transplant liver biopsies to judge disease recurrence rates.

The researchers reported no conflicts of interest.

Primary source: Liver Transplantation
Source reference:
Bhagat V, et al "Outcomes of liver transplantation in patients with cirrhosis due to nonalcoholic steatohepatitis versus patients with cirrhosis due to alcoholic liver disease" Liver Transpl 2009; 15: 1814-20.