The influence of nonalcoholic fatty liver disease and its associated comorbidities on liver transplant outcomes - PubMed (original) (raw)

The influence of nonalcoholic fatty liver disease and its associated comorbidities on liver transplant outcomes

A Sidney Barritt 4th et al. J Clin Gastroenterol. 2011 Apr.

Abstract

Goals: To define the influence of nonalcoholic fatty liver disease (NAFLD) and its associated comorbidities on liver transplant outcomes.

Background: NAFLD cirrhosis is an increasing indication for transplant. The transplant outcomes of NAFLD patients with metabolic syndrome comorbidities remain unclear.

Study: We examined a single center, retrospective cohort between 2004 and 2007 to determine transplant mortality for NAFLD and non-NAFLD patients accounting for the possible independent effects of diabetes, hypertension, obesity, and hyperlipidemia. The primary outcomes were 30-day, 1-year, and 3-year all-cause mortality. Cox proportional hazard ratios were determined controlling for various recipient and donor covariates.

Results: In our study, of 118 liver transplants, 18% were performed for NAFLD cirrhosis. Adjusted hazard ratios for death for NAFLD compared with non-NAFLD patients at 30 days, 1 year, and 3 years were 8.96 (1.06, 75.8), 1.49 (0.38, 5.81), and 1.05 (0.29, 3.78), respectively. Compared with nondiabetic patients, diabetic patients had hazard ratios at 30 days, 1 year, and 3 years of 2.02 (0.31, 12.9), 2.82 (0.94, 8.47), 3.58 (1.32, 9.71), respectively. Obesity, hypertension, and hyperlipidemia did not have a significant impact on posttransplant mortality.

Conclusions: We conclude that NAFLD increases 30-day transplant mortality whereas diabetes increases 3-year mortality. Future work should determine the strategies to decrease perioperative mortality among NAFLD patients and ways to improve long-term transplant survival among diabetics.

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Conflict of interest statement

Conflicts of Interest: None.

Figures

FIGURE 1

FIGURE 1

Selection of the NAFLD cohort. Risk factors for a clinical diagnosis of NAFLD defined as hypertension, hyperlipidemia, diabetes, and obesity. NAFLD indicates nonalcoholic fatty liver disease.

FIGURE 2

FIGURE 2

Kaplan-Meier survival curves for patients with and without NAFLD. Unadjusted P values for log-rank Kaplan-Meier curve censored at day 30 (P = 0.001), day 365 (P = 0.063), and day 1095 (P = 0.235). NAFLD indicates nonalcoholic fatty liver disease.

FIGURE 3

FIGURE 3

Kaplan-Meier survival curves for patients with and without diabetes. Unadjusted P values for log-rank Kaplan-Meier curve censored at day 30 (_P_=0.232), day 365 (_P_=0.076), and day 1095 (_P_=0.006).

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