Additive impact of pre‐liver transplant metabolic factors on survival post‐liver transplant

Adams, Leon A.; Arauz, Oscar; Angus, Peter W; Sinclair, Marie; Macdonald, Graeme A.; Chelvaratnam, Utti; Wigg, Alan; Yeap, Sze; Shackel, Nicholas; Lin, Linda; Raftopoulos, Spiro; McCaughan, Geoffrey W.; Jeffrey, Gary P.

doi:10.1111/jgh.13240

Cited by 28 publications

(28 citation statements)

References 31 publications

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“…Currently, NASH-related cirrhosis is frequently missed as a diagnosis with the consequence of presenting with more advanced liver disease and HCC, thereby limiting potential curative options including transplantation. (30) In addition, with the increasing prevalence of metabolic factors (diabetes, overweight, or obesity), which have a negative impact on wait-list dropout rates (31) and survival after LT, (32) strategies to optimize weight and diabetes control and avoid sarcopenia should be prioritized in these patients within LT programs.…”

Section: Original Article | 33mentioning

confidence: 99%

Increasing Incidence of Nonalcoholic Steatohepatitis as an Indication for Liver Transplantation in Australia and New Zealand

et al. 2019

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The worldwide increase in obesity and diabetes has led to predictions that nonalcoholic steatohepatitis (NASH) will become the leading indication for orthotopic liver transplantation (OLT). Data supporting this prediction from outside the United States are limited. Thus, we aimed to determine trends in the frequency of NASH among adults listed and undergoing OLT in Australia and New Zealand (ANZ) from 1994 to 2017. Data from the ANZ Liver Transplant Registry were analyzed with patients listed for fulminant liver failure, retransplantation, or multivisceral transplants excluded. Nonparametric trend, Spearman rank correlation, and regression analysis were used to assess trends in etiologies of liver disease over time. Of 5016 patient wait‐list registrants, a total of 3470 received an OLT. The percentage of patients with NASH activated for OLT increased significantly from 2.0% in 2003 to 10.9% in 2017 (trend analyses; P < 0.001). In 2017, NASH was the third leading cause of chronic liver disease (CLD) among wait‐list registrants behind chronic hepatitis C virus (HCV; 29.5%) and alcohol (16.1%). Similarly, significant increases over time in the percentage of patients undergoing OLT were observed for HCV and NASH (all trend analyses; P < 0.001) but with significant reductions in primary sclerosing cholangitis and cryptogenic cirrhosis (both P < 0.05). By 2017, NASH was the third leading cause of liver disease among patients undergoing OLT (12.4%) and behind chronic HCV (30.2%) and alcohol (18.2%). NASH also became the third most frequent etiology of CLD in patients transplanted (13.8%) with concomitant hepatocellular carcinoma by 2017. In conclusion, NASH is increasing as a primary etiology of liver disease requiring listing and liver transplantation in ANZ.

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Section: Original Article | 33mentioning

confidence: 99%

Increasing Incidence of Nonalcoholic Steatohepatitis as an Indication for Liver Transplantation in Australia and New Zealand

et al. 2019

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“…[4][5][6] This might be due to the fact that OB patients have concomitant predisposing factors for HCC such as the presence of nonalcoholic fatty liver disease (NAFLD) or chronic and systemic inflammatory status caused by excessive adipose tissue. 7,8 Studies on obese patients undergoing liver transplantation (LT) for HCC have also shown inferior survival when compared to normal weight patients ( [9][10][11] or patients with higher ratio between visceral fat and muscular mass (12). However, these studies are from single centers and less generalizable.…”

Section: Introductionmentioning

confidence: 99%

Recipient obesity does not affect survival after deceased donor liver transplantation for hepatocellular carcinoma. A national retrospective cohort study in the United States

Ata

Ayloo

Tsung

et al. 2019

HPB

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Background: The oncological effects of obesity on liver transplant (LT) patients with hepatocellular carcinoma (HCC) remains unclear. We investigated patient overall survival and tested two-way interactions between donor and recipient obesity status. Methods: Using the UNOS database, a total of 8352 LT recipients with HCC were included. Donors and recipients were stratified in normal weight (NW), overweight (OW) and obese (OB). Hazard ratios (HR) for any cause of death and interactions between recipient and donor BMI were estimated by multivariate flexible parametric models. Results: Five-year overall survival was 66% for NW, 67% for OW and 68% for OB recipients. The HRs of death from all causes were 0.96 (95% CI: 0.86-1.08) for OW and 0.93 (95% CI: 0.82-1.05) for OB recipients when compared to NW patients. At multivariate analysis, predictors of inferior survival were recipient age (65 years), donor age (45 years), need for pre-operative dialysis, HCV infection, transplants performed before 2007, and UNOS regions 2,3,9,10, and 11. The lowest adjusted HR was measured for recipients with BMI between 25 and 35 and there were no interactions between recipient and donor BMI. Conclusions: the overall survival of LT recipients with HCC was not affected by donor or recipient obesity.

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“…Seminal findings in the following fields have been published as a result of these collaborations: posttransplant prevention of hepatitis B recurrence after transplant, outcomes of LT in HCC patients selected according the UCSF criteria, outcomes of LT in patients transplanted for hepatitis C–related cirrhosis, prevention of bone disease after LT, outcomes for patients with hemochromatosis, outcomes for patients of Aboriginal or Torres Straight ethnicity, rates of colorectal malignancy, and longterm outcomes for liver transplant patients surviving beyond 12 months . More recently the effect of pretransplant metabolic factors on longer‐term outcomes have been described for liver transplant recipients in Australia and New Zealand …”

Section: Discussionmentioning

confidence: 99%

“…(16) More recently the effect of pretransplant metabolic factors on longer-term outcomes have been described for liver transplant recipients in Australia and New Zealand. (17) FIG. 5.…”

Section: Australian and New Zealand Liver Transplant Clinical Researcmentioning

confidence: 99%

Liver transplantation in Australia and New Zealand

McCaughan

Munn

2016

Liver Transpl

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Liver transplantation (LT) in Australia and New Zealand began in 1985. Over this time until December 2014, LT took place in 3700 adults and 800 children. LT is regulated with 1 unit, supported by the government, per state or region. Currently approximately 270 transplants take place per year. Organ donation rates are moderate in Australia (17 per 1 million of population) but very low in New Zealand (11 per 1 million of population). All the units share organ donors for fulminant hepatic failure cases (status 1). Recipient listing criteria and organ allocation criteria are commonly agreed to via National and Trans‐Tasman agreements, which are published online. Current survival rates indicate approximately 94% 1‐year survival with median survival in adults of approximately 20 years, whereas 75% of children are alive at 20 years. All units collaborate in research projects via the Australia and New Zealand Liver Transplant Registry and have published highly cited articles particularly on the prevention of hepatitis B virus recurrence. Outcomes for indigenous populations have also been analyzed. In conclusion, LT in Australia and New Zealand is well developed with transparent processes related to criteria for listing and organ allocation together with publication of outcomes. Liver Transplantation 22 830–838 2016 AASLD.

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Additive impact of pre‐liver transplant metabolic factors on survival post‐liver transplant

Abstract: Concomitant diabetes and obesity but not each condition in the absence of the other is associated with reduced post-liver transplant survival. The impact of diabetes and obesity is greater in older patients and those with hepatocellular carcinoma.

Cited by 28 publications

References 31 publications

Increasing Incidence of Nonalcoholic Steatohepatitis as an Indication for Liver Transplantation in Australia and New Zealand

Increasing Incidence of Nonalcoholic Steatohepatitis as an Indication for Liver Transplantation in Australia and New Zealand

Recipient obesity does not affect survival after deceased donor liver transplantation for hepatocellular carcinoma. A national retrospective cohort study in the United States

Liver transplantation in Australia and New Zealand

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