Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis in Liver Transplantation

Carter, Danielle; Dieterich, Douglas T.; Chang, Charissa

doi:10.1016/j.cld.2017.08.015

Cited by 17 publications

(12 citation statements)

References 82 publications

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“…NAFLD/NASH is frequently described as the hepatic manifestation of metabolic syndrome [ 26 ]. As a result, patients with NASH carry a distinct set of comorbidities and risk factors that deserve special attentions [ 27 ]. Although hepatic biopsy is the gold standard to diagnose NASH, the procedure comes with a risk of major complications in 1–3% of patients and death in 0.01% of patients [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Higher non-HDL-cholesterol to HDL-cholesterol ratio linked with increased nonalcoholic steatohepatitis

Wang

Chen

et al. 2018

Lipids Health Dis

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BackgroundNon-HDL-cholesterol to HDL-cholesterol (non-HDL-c/HDL-c) ratio is a feasible predictor for coronary heart disease, metabolic syndrome, and insulin resistance. Patients with nonalcoholic steatohepatitis (NASH) have an increased risk of developing cardiovascular problems and type 2 diabetes. However, the predictive role of non-HDL-c/HDL-c ratio in NASH hasn’t been investigated yet.MethodsWe conducted a retrospective cohort study. A total of 3489 eligible subjects were selected in the present study. Prevalence and characteristics of NASH were demonstrated. Conditional logistic regression was used to analyze the association between non-HDL-c/HDL-c ratio and risks of NASH. Associations between non-HDL-c/HDL-c ratio and serum aminotransferase levels were also investigated.ResultsThe overall prevalence of NASH was 6.13%, higher in male (6.89%) than that in female (5.04%). Interestingly, the prevalence of NASH showed a positive correlation with the elevation of non-HDL-c/HDL-c ratio (Pearson’s Chi-squared test, linear trend 0.010, p < 0.05). The risk of NASH increased approximately 1.8-fold among subjects with higher non-HDL-c/HDL-c ratio. After adjustment for confounding factors, higher non-HDL-c/HDL-c ratio was still associated with a 54.4% increased risk of NASH. Male had higher risk of NASH than female when their non-HDL-c/HDL-c ratio increased. The risk of NASH in subjects with BMI more than 24 was 3 times higher than that in subjects with BMI less than 24. Every one unit increase in Non-HDL-c/HDL-c ratio was associated with 64.5% increase in ALT/AST level (p < 0.05) after adjustment for confounding factors.ConclusionsOur study provided strong evidence that subjects with higher non-HDL-c/HDL-c ratio had a higher risk of NASH, which suggested that non-HDL-c/HDL-c ratio might be a feasible predictor for NASH.

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Section: Discussionmentioning

confidence: 99%

Higher non-HDL-cholesterol to HDL-cholesterol ratio linked with increased nonalcoholic steatohepatitis

Wang

Chen

et al. 2018

Lipids Health Dis

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“…Obesity-related liver disease is the fastest growing indication for liver transplantation (LT) in the United States. (1) In LT recipients, obesity is associated with an increased incidence of wound infections and dehiscence, biliary and cardiopulmonary complications, and overall infection, and confers a higher risk of post-LT complications related to metabolic syndrome. (2,3) As such, morbid obesity (body mass index [BMI] ≥40 kg/ m 2 ) is considered a relative contraindication to LT at many transplant centers.…”

Section: See Editorial On Page 531mentioning

confidence: 99%

Outcomes of Sleeve Gastrectomy in Obese Liver Transplant Candidates

2019

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Morbid obesity (body mass index [BMI] ≥40 kg/m2) is a relative contraindication to liver transplantation (LT) at many transplant centers. The safety and efficacy of pre-LT bariatric surgery in morbidly obese LT candidates is unknown. Herein, we describe a cohort study of morbidly obese LT candidates who failed to achieve adequate weight loss through a medically supervised weight loss program and subsequently underwent sleeve gastrectomy (SG) at our institution. In total, 32 LT candidates with a median Model for End-Stage Liver Disease (MELD) score of 12 (interquartile range [IQR], 10–13) underwent SG. All LT candidates had a history of hepatic decompensation, but complications of liver disease were required to be well controlled at the time of SG. Median pre-SG BMI was 45.0 kg/m2 (IQR, 42.1–49.0 kg/m2). There were no perioperative deaths or liver-related morbidity. One patient experienced major perioperative morbidity secondary to a gastric leak, which was managed nonoperatively. Median weight loss at 6 and 12 months after SG was 22.0 kg (IQR, 18.9–26.8 kg) and 31.0 kg (IQR, 23.6–50.3 kg), respectively, corresponding to a percentage of excess body weight lost of 33.4% and 52.4%. Within 6 months after SG, 28 (88%) candidates were deemed eligible for LT. Our center’s experience highlights the potential option of SG in morbidly obese LT candidates with advanced liver disease who might otherwise be excluded from pursuing LT.

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“…60,61 Therefore, it is not surprising that in patients with NASH who undergo LT, up to 70% also carry a diagnosis of diabetes. 62,63 Diabetes prior to LT is a strong predictor of early posttransplant complications, cardiovascular mortality, and overall decreased patient survival. 64,65 In a retrospective cohort study of 12,442 patients who underwent LT, Hoehn et al reported longer hospital length of stay; higher peritransplant mortality, 30-day mortality, and 30-day readmission rates; and inferior graft and patient survival in those who had diabetes when compared with those without diabetes.…”

Section: Diabetesmentioning

confidence: 99%

“…79 Patients who are dialysis-dependent and are obese have a decreased 3-year posttransplant survival rate. 63 In patients with both liver and kidney injuries, simultaneous liver/kidney (SLK) transplantation is often required. With the rising prevalence of NAFLD and CKD, NASH cirrhosis is the most rapidly growing indication for SLK transplantation.…”

Section: Renal Diseasementioning

confidence: 99%

Multidisciplinary Approach for Liver Transplantation in Patients with Nonalcoholic Steatohepatitis: It Takes a Village

2020

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Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease in Western countries, and its aggressive form, nonalcoholic steatohepatitis (NASH), is a leading cause of cirrhosis and end-stage liver disease. The total number of new liver transplantation waitlist registrants with NASH continues to increase rapidly, making NASH the second most common indication for liver transplantation. Compared with recipients for other etiologies, patients with NASH often have higher rates of obesity, diabetes, dyslipidemia, hypertension, kidney disease, and cardiac disease. Many of these medical comorbidities are independently associated with increased preoperative risk and both short- and long-term complications. The presence of these particular risk factors necessitates the need for early detection, medical optimization, and careful preoperative care. Bariatric surgery is an effective strategy for weight loss and ultimately reducing obesity-related medical complications. In select patients, bariatric surgery—before, during, or after liver transplantation—may be useful to help improve posttransplant outcomes. NAFLD/NASH can present after liver transplantation and occurs as either recurrent or de novo disease. Posttransplant NAFLD occurs in the setting of metabolic syndrome, immunosuppression use, and genetic determinants. Future studies and efforts should focus on optimizing medical management strategies to further improve transplant outcomes in patients with NAFLD.

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Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis in Liver Transplantation

Cited by 17 publications

References 82 publications

Higher non-HDL-cholesterol to HDL-cholesterol ratio linked with increased nonalcoholic steatohepatitis

Higher non-HDL-cholesterol to HDL-cholesterol ratio linked with increased nonalcoholic steatohepatitis

Outcomes of Sleeve Gastrectomy in Obese Liver Transplant Candidates

Multidisciplinary Approach for Liver Transplantation in Patients with Nonalcoholic Steatohepatitis: It Takes a Village

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