Outcomes of liver transplantation for cryptogenic cirrhosis: a single-center study of 71 patients

Sanjeevi, Arthi; Lyden, Elizabeth; Sunderman, Brandy; Weseman, Rebecca A.; Ashwathnarayan, Ramesh; Mukherjee, Sandeep

doi:10.1016/j.transproceed.2003.10.059

Cited by 47 publications

(31 citation statements)

References 11 publications

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“…Five-year survival rates post-LT in adults with cryptogenic cirrhosis range from 72% to 81%. 10,22 Sanjeevi et al 20 and Heneghan et al 22 showed that short-term and 5-year post-LT graft survival and patient survival for patients with cryptogenic cirrhosis were comparable to those for patients with other causes of cirrhosis. Contos et al 19 showed that post-LT graft survival and patient survival for patients with cryptogenic cirrhosis and the NASH phenotype were similar to those for patients with ETOH and primary biliary cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

“…10 Moreover, the liver disease often recurs in the transplanted livers of NAFLD patients, and some develop NASH and consequently cirrhosis requiring retransplantation. 12,19,20 The prognosis and post-LT outcomes of NASH cirrhosis have not been well defined; hence, we performed a retrospective analysis of NASH patients who underwent LT at our center from January 1997 through January 2007. ETOH is a common indication for LT and is associated with very good post-LT outcomes if the patient remains abstinent from further alcohol use.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of liver transplantation in patients with cirrhosis due to nonalcoholic steatohepatitis versus patients with cirrhosis due to alcoholic liver disease

Bhagat¹,

Mindikoğlu²,

Nudo³

et al. 2009

Liver Transpl

165

142

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Nonalcoholic steatohepatitis (NASH) is becoming a common cause of liver cirrhosis requiring liver transplantation (LT). Cardiovascular complications related to metabolic syndrome and NASH recurrence in the transplanted liver may affect the outcome of LT in these patients. We compared the outcomes of LT for NASH cirrhosis and alcoholic cirrhosis (ETOH) in a large transplant center. A retrospective chart review was performed for all patients who underwent LT for cryptogenic cirrhosis with the NASH phenotype (the NASH group) or ETOH (the ETOH group) at the University of Miami from January 1997 to January 2007. There was no significant difference in survival between the NASH and ETOH groups, despite a trend toward lower survival in the former (P ϭ 0.1699). Sepsis was the leading cause of posttransplant death in both groups, and it was followed by cardiovascular causes in the NASH group (26% versus 7% in the ETOH group, P ϭ 0.21) and malignancies in the ETOH group (29% versus 0% in the NASH group, P ϭ 0.024). Recurrent steatohepatitis (33% versus 0%, P Ͻ 0.0001) and acute rejection (41% versus 23%, P Ͻ 0.023) were significantly more frequent in the NASH group than in the ETOH group. There was no difference in graft failure between the groups (24% in the NASH group versus 18% in the ETOH group, P ϭ 0.3973).In conclusion, despite a numerical trend favoring the ETOH group, there were no statistically significant differences in posttransplant survival and cardiovascular mortality between the NASH and ETOH groups. Acute rejection and recurrent steatohepatitis were significantly more frequent in the NASH group but did not lead to higher rates of retransplantation. Liver

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outcomes of liver transplantation in patients with cirrhosis due to nonalcoholic steatohepatitis versus patients with cirrhosis due to alcoholic liver disease

Bhagat¹,

Mindikoğlu²,

Nudo³

et al. 2009

Liver Transpl

165

142

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“…The incidence of recurrent steatosis in patients transplanted for cryptogenic cirrhosis or NASH-cirrhosis ranges from 25%-100%, while NASH development is observed in 10%-37.5% of these cases without leading to early allograft failure (reviewed in [135] ). Recurrent NASH can progress to advanced fibrosis and cirrhosis, but only rare cases have been re-transplanted as a result of decompensation due to severe NASH in the allograft [137] . Development of de novo steatosis and/or NASH in the liver allograft might be the result of metabolic disturbances, as transplanted patients are at increased risk for obesity, diabetes, hypertension, and hypercholesterolemia and have decreased physical activity levels.…”

Section: Nash In the Transplanted Livermentioning

confidence: 99%

Histopathology of Non-Alcoholic Fatty Liver Disease

Brunt

2009

Clinics in Liver Disease

115

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Histological analysis of liver biopsies remains a standard against which other methods of assessment for the presence and amount of hepatic injury due to nonalcoholic fatty liver disease (NAFLD) are measured. Histological evaluation remains the sole method of distinguishing steatosis from advanced forms of NAFLD, i.e. nonalcoholic steatohepatitis (NASH) and fibrosis. Included in the lesions of NAFLD are steatosis, lobular and portal inflammation, hepatocyte injury in the forms of ballooning and apoptosis, and fibrosis. However, patterns of these lesions are as distinguishing as the lesions themselves. Liver injury in adults and children due to NAFLD may have different histological patterns. In this review, the rationale for liver biopsy, as well as the histopathological lesions, the microscopically observable patterns of injury, and the differential diagnoses of NAFLD and NASH are discussed.

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“…A portion of these cases is attributed to non-alcoholic steatohepatitis (NASH), since, when cirrhosis is established, patients no longer present typical histological characteristics of NASH, thus, preventing its clinical recognition (1,8,24) . A causal relationship between both entities could be suggested by the study of risk factors for NASH in patients with CC and/or by following NASH cases with serial liver biopsies (4,7,9,16,17,22,23,26,27,30,31) . Most NASH cases are associated with insulin resistance (IR), so that nonalcoholic fatty liver disease (NAFLD) has been considered the hepatic component of metabolic syndrome (MS) (11,20) .…”

Section: Introductionmentioning

confidence: 99%

Risk factors for nonalcoholic steatohepatitis in cryptogenic cirrhosis

Leite

Mattos

Coral

et al. 2012

Arq. Gastroenterol.

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-Context -In about 10% of patients with chronic liver disease, it is not possible to identify an etiologic factor. These cases are called cryptogenic cirrhosis. Currently, nonalcoholic steatohepatitis (NASH) is being considered as a possible etiologic factor for a significant segment of patients that presents with cryptogenic cirrhosis. Objective -To estimate the prevalence of risk factors for NASH in patients with cryptogenic cirrhosis, in order to verify if there is a causal relationship between them. Method -Cross-sectional study, with evaluation of the demographic and laboratorial data of patients with cryptogenic cirrhosis. They were compared with data obtained from a group with NASH and a group with alcoholic and/or hepatitis C (HCV) cirrhosis. Results -Forty seven patients with cryptogenic cirrhosis were evaluated, 47 with NASH and 196 with HCV and/or alcoholic cirrhosis. The mean age of patients with cryptogenic cirrhosis was 52 years, while in those with NASH it was 46.4 years (P = 0,041). The group with cryptogenic cirrhosis had 23 female and 24 male patients. Of the patients who presented with NASH, 68.1% were female. Of the patients who presented with alcoholic/HCV cirrhosis, 64.8% were male. There were no statistically significant differences between the groups. In cryptogenic cirrhosis patients, the following prevalences could be observed: impaired fasting glycemia -68.2%; obesity -27.5%; total hypercholesterolemia -27.9%; low HDL levels -58.1% (women -81%; men -36.4%); hypertriglyceridemia -16.3%. The results seen in cryptogenic cirrhosis patients showed statistical similarity with the results of the NASH group regarding fasting glycemia (62.8%) and male HDL levels (53.8%). The comparison with the alcoholic/HCV cirrhosis group showed statistical differences regarding fasting glycemia (45.2%), hypercholesterolemia (13.3%) and female HDL levels (50.8%). Conclusions -It is not possible to establish a causal relationship between cryptogenic cirrhosis and NASH. Only data related to fasting glycemia and HDL levels in male patients showed statistical similarities between both groups of patients. HEADINGS -Liver cirrhosis. Fatty liver. Metabolic diseases.Declared conflict of interest of all authors: none.

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Outcomes of liver transplantation for cryptogenic cirrhosis: a single-center study of 71 patients

Cited by 47 publications

References 11 publications

Outcomes of liver transplantation in patients with cirrhosis due to nonalcoholic steatohepatitis versus patients with cirrhosis due to alcoholic liver disease

Outcomes of liver transplantation in patients with cirrhosis due to nonalcoholic steatohepatitis versus patients with cirrhosis due to alcoholic liver disease

Histopathology of Non-Alcoholic Fatty Liver Disease

Risk factors for nonalcoholic steatohepatitis in cryptogenic cirrhosis

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