Epidemiology

Liver transplantation for nonalcoholic steatohepatitis appears safe

Last Updated: 2009-11-30 16:19:11 -0400 (Reuters Health)

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - Liver transplantation for nonalcoholic steatohepatitis (NASH) is associated with survival and retransplantation rates comparable to those seen with transplantation for alcohol-related cirrhosis, a single-center study has shown.

"Our study presents the largest patient population with the longest follow-up published so far on the survival of patients with NASH cirrhosis," lead author Dr. Vishal Bhagat, from the University of Miami, told Reuters Health. "Our results show that although there was a trend towards lower patient survival in the NASH group compared with the alcohol group, the difference was not statistically significant."

Liver transplantations for NASH cirrhosis have been on the rise, according to the report in the December issue of Liver Transplantation. The risks of NASH recurrence or metabolic syndrome-related cardiovascular complications after transplant were unclear, however.

To investigate, the researchers compared the outcomes of 71 patients with NASH and 83 patients with alcoholic cirrhosis, all of whom had liver transplantation at their center from 1997 to 2007.

Although patient survival tended to be lower in the NASH group, there was no statistically significant difference. Overall, on Kaplan-Meier analysis, 1-year and 5-year patient survival rates were 82% and 75%, respectively, in the NASH group and 92% and 86%, respectively, in the alcoholic cirrhosis group.

Graft failure rates were also comparable in the NASH and ETOH groups: 24% vs. 18%.

Sepsis was the main cause of posttransplant death in both groups, accounting for 53% of deaths in the NASH group and 43% in the alcohol group. More patients died from cardiovascular causes in the NASH group (26%) than in the alcohol group (7%), but again, the difference was not statistically significant (p = 0.21).

By contrast, a significantly higher rate of cancer-related deaths was seen in the alcohol group: 29% vs. 0% in the NASH group (p = 0.024).

Recurrent steatohepatitis developed in 33% of NASH patients.

"NASH cirrhosis is an acceptable indication for liver transplantation with post-transplant survival rates similar to other causes of cirrhosis," Dr. Bhagat emphasized. "Aggressive control of the metabolic syndrome has a role in posttransplant management of these patients, not only to prevent disease recurrence in the transplanted liver but also to prevent cardiovascular mortality."

Liver Transpl 2009;15:1814-1820.