The Influence of Nonalcoholic Fatty Liver Disease... : Journal of Clinical Gastroenterology (original) (raw)

LIVER, PANCREAS AND BILIARY TRACT: Original Articles

The Influence of Nonalcoholic Fatty Liver Disease and Its Associated Comorbidities on Liver Transplant Outcomes

A. Sidney Barritt
Evan S. Dellon
Tomasz Kozlowski
David A. Gerber
Paul H. Hayashi

Journal of Clinical Gastroenterology

(

)

372

378

April 2011

| DOI: 10.1097/MCG.0b013e3181eeaff0

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.