Liver Transplantation in Nonalcoholic Steatohepatitis Is Associated with High Mortality and Post-Transplant Complications: A Single-Center Experience

Abstract

Background/Aims: Non-alcoholic fatty liver disease (NAFLD) with its progressive form nonalcoholic steatohepatitis (NASH) is the most common chronic liver disease in western countries which is associated with end-stage liver disease and hepatocellular carcinoma (HCC). This entity is a consistently increasing indication for transplantation. However, data about postsurgery outcome and complications are still limited. Patients and Methods: Records of 432 consecutive transplanted patients between October 2007 and January 2011 were investigated retrospectively. Forty transplants were performed due to NASH-induced cirrhosis. Perioperative courses and short- and long-term outcomes were analyzed. Results: The NAFLD population consisted of 16 women and 24 men with a mean age of 55 years. The median MELD score was 27 at the time of liver transplantion. BMI before surgery ranged from 21 to 45 (mean 31). Sixteen of the initial 40 patients are still alive. Patients with sustained obesity and features of the metabolic syndrome had a worse 1-year mortality rate of 42%. Conclusions: A significant number of liver transplantations in our center was performed due to NASH; transplantation in this cohort was associated with high mortality and postoperative complications, most likely due to associated obesity and diabetes. Weight reduction prior to surgery may lead to a better outcome.

Glutamate Dehydrogenase and Alkaline Phosphatase as Very Early Predictors of Hepatocellular Carcinoma Recurrence after Liver Transplantation

“…At the same time, the importance of NASH as an indicator for transplant is also consistently increasing [20]. However, NASH has been reported to be associated with high rates of mortality and postoperative complications, probably because it is associated with obesity and diabetes [21]. Nevertheless, NASH is an increasingly common cause of HCC, even in noncirrhotic livers [22].…”

EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease

“…The 3-and 5-year survival is not different in NAFLD vs. no-NAFLD; NAFLD carries a higher risk of death from cardiovascular complications and sepsis, whereas the risk of graft failure is lower [145,146] . The overall mortality is associated with BMI and diabetes, with 50% of cases with BMI > 35 kg/m 2 dying within 1 year of transplantation [147] . Transplant failure (10% and 45% at 10 and 20 years, respectively [148] ) in obese patients is rarely associated with recurrent NASH cirrhosis ( ≈ 2%) [146] .…”

Vascular Endothelial Growth Factor Improves Liver Regeneration and Survival after 90% Hepatectomy in a Rat Model of Diet-Induced Steatosis

“…In addition, obesity in humans leads to elevated circulating VEGF levels [35]. Taken together, VEGF may be increased in obese subjects, without beneficial effects on surgical outcome, as the clinical situation demonstrates [16]. VEGF itself only marginally affects insulin resistance or effects of obesity, suggesting a direct impact of VEGF treatment on cellular regeneration as demonstrated by increased Ki-67-positive cell numbers.…”

“…It is known that this entity is associated with increased mortality and morbidity after liver resection [16]. Thus, therapeutic strategies to improve regeneration and functional recovery of the remnant liver are very important in these patients [17,18].…”