The impact of gender and <scp>NASH</scp> on chronic kidney disease before and after liver transplantation

Fussner, Lynn A.; Charlton, Michael; Heimbach, Julie K.; Fan, Chun; Dierkhising, Ross A.; Coss, Elizabeth; Watt, Kymberly D.

doi:10.1111/liv.12381

Cited by 55 publications

(42 citation statements)

References 27 publications

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“…Patients transplanted for NASH cirrhosis also have a higher rate of chronic kidney disease after transplantation. 115 Any patient developing signs of decompensated cirrhosis, such as ascites, hepatic encephalopathy or variceal bleed, and/or a model for end-stage liver disease score ≥10 should be referred to a transplant center for evaluation. 116 …”

Section: Referral For Consideration Of Liver Transplantationmentioning

confidence: 99%

Recommendations for Diagnosis, Referral for Liver Biopsy, and Treatment of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis

Spengler

Loomba

2015

Mayo Clinic Proceedings

225

180

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Nonalcoholic fatty livery disease (NAFLD) is the primary cause of chronic liver disease in the United States, afflicting an estimated 80–100 million Americans. NAFLD is a spectrum of liver diseases comprised of nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). Whereas NAFL has negligible risk of progression, NASH patients often develop cirrhosis or hepatocellular carcinoma. Although liver biopsy is required to diagnose NASH, only patients with a high risk of NASH or advanced fibrosis require this evaluation. Despite the high prevalence of NAFLD, well-defined screening recommendations are currently lacking. In this review, suggestions for screening, diagnosis and initial work-up of NAFLD are given based on established guidelines and recent publications. Proposed drug treatments for NASH are also discussed, highlighting the study outcomes, as well as proposed uses and limitations of these drugs. PubMed was used with search terms nonalcoholic fatty liver disease and nonalcoholic steatohepatitis with filters of “English language.” A date range of January 1, 2000 to May 1, 2015 was used for the search. The bibliographies of key references were also manually searched and seminal publications before the year 2000 were included.

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Section: Referral For Consideration Of Liver Transplantationmentioning

confidence: 99%

Recommendations for Diagnosis, Referral for Liver Biopsy, and Treatment of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis

Spengler

Loomba

2015

Mayo Clinic Proceedings

225

180

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“…The complications of cirrhosis have and will lead to more hospitalizations and acute‐on‐chronic liver failure (ACLF), which will increase the demand for liver transplantation (LT) . In addition, we expect to transplant older people with more chronic kidney disease (CKD) secondary to the decline in hepatitis B virus– and hepatitis C virus (HCV)–related advanced liver disease and a continued increase in the prevalence of NAFLD …”

mentioning

confidence: 99%

Outcomes After Listing for Liver Transplant in Patients With Acute‐on‐Chronic Liver Failure: The Multicenter North American Consortium for the Study of End‐Stage Liver Disease Experience

et al. 2019

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Acute‐on‐chronic liver failure (ACLF) characterized with ≥2 extrahepatic organ failures in cirrhosis carries a high mortality. Outcomes of patients listed for liver transplantation (LT) after ACLF and after LT are largely unknown. The North American Consortium for the Study of End‐Stage Liver Disease prospectively enrolled 2793 nonelectively hospitalized patients with cirrhosis; 768 were listed for LT. Within 3 months, 265 (35%) received a LT, 395 remained alive without LT, and 108 died/delisted. Compared with nonlisted patients, those listed were younger and more often had ACLF, acute kidney injury, and a higher admission Model for End‐Stage Liver Disease (MELD) score. ACLF was most common in patients who died/delisted, followed by those alive with and without LT respectively, (30%, 22%, and 7%, respectively; P < 0.001). At LT, median MELD was 27.9% and 70% were inpatients; median time from hospitalization to LT was 26 days. Post‐LT survival at 6 months was unchanged between those with and without ACLF (93% each at 6 months). There was no difference in 3‐ and 6‐month mean post‐LT creatinine in those with and without ACLF, despite those with ACLF having a higher mean pre‐LT creatinine and a higher rate of perioperative dialysis (61%). In conclusion, patients with and without ACLF had similar survival after transplant with excellent renal recovery in both groups.

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“…Some older studies proposed that female livers have a lower survival and that a gender mismatch leads to higher graft failure; however, more recent studies could not support the assumed outcome differences related to donor gender [4,15,33,35,47,48,49,50,51,52]. During follow-up, no gender-related differences are being observed in the incidence of malignancies or rejections; however, more women develop renal dysfunction after liver transplantation [15,23,50,51,52,53,54,55]. …”

Section: Liver Transplantationmentioning

confidence: 92%

Gender Mainstreaming and Transplant Surgery

et al. 2016

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Background: Gender differences in medicine are gaining in importance. In transplant surgery, not only the patient's gender but also that of the donor play an important role in the outcome of transplantation due to sociocultural and genetic factors. Methods: This review article gives an overview of the latest investigations into gender-related influences in the field of visceral transplantation. For this purpose, a systematic review of the literature was performed. Results: In general, women are less often evaluated for and subjected to transplantation worldwide. Significantly poorer outcome can be observed in women with liver transplantation following hepatitis C cirrhosis. Furthermore, female renal grafts are less favorable in terms of outcome and survival. Gender disparities affect transplant medicine due to subtle gender-specific immunological factors. Sociocultural factors also lead to differences in the clinical treatment of men and women, which may influence overall survival. Conclusion: For a better understanding of gender-specific differences in transplant medicine and a possible improvement in outcome, further research in this field is necessary.

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The impact of gender and NASH on chronic kidney disease before and after liver transplantation

Abstract: In addition to age and pre-LT CKD, female gender and NASH are independent predictors of ≥stage 3 CKD post-LT. Gender-based approaches to optimize modifiable risk factors are needed to improved post-transplant renal function.

Cited by 55 publications

References 27 publications

Recommendations for Diagnosis, Referral for Liver Biopsy, and Treatment of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis

Recommendations for Diagnosis, Referral for Liver Biopsy, and Treatment of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis

Outcomes After Listing for Liver Transplant in Patients With Acute‐on‐Chronic Liver Failure: The Multicenter North American Consortium for the Study of End‐Stage Liver Disease Experience

Gender Mainstreaming and Transplant Surgery

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