Recurrence of non-alcoholic steatohepatitis and cryptogenic cirrhosis following orthotopic liver transplantation in the context of the metabolic syndrome

Background Non‐alcoholic steatohepatitis (NASH) and cryptogenic cirrhosis (CC) are increasing indications for orthotopic liver transplantation (OLT). The aim of this study is to describe our outcomes and delineate predictors of recurrence of NASH and CC after OLT. Methods This is a retrospective stu...

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Published in:	Clinical transplantation Vol. 26; no. 5; pp. E505 - E512
Main Authors:	El Atrache, Mazen M., Abouljoud, Marwan S., Divine, George, Yoshida, Atsushi, Kim, Dean Y., Kazimi, Marwan M., Moonka, Dilip, Huang, Mary A., Brown, Kim
Format:	Journal Article
Language:	English
Published:	Denmark Blackwell Publishing Ltd 01-09-2012
Subjects:	Adult Aged cryptogenic cirrhosis Fatty Liver - diagnosis Fatty Liver - etiology Fatty Liver - mortality Female Follow-Up Studies Humans Liver Cirrhosis - diagnosis Liver Cirrhosis - etiology Liver Cirrhosis - mortality liver transplantation Liver Transplantation - adverse effects Male metabolic disease Metabolic Syndrome - complications Metabolic Syndrome - mortality Metabolic Syndrome - therapy Middle Aged Non-alcoholic Fatty Liver Disease non-alcoholic steatohepatitis Prognosis Recurrence Retrospective Studies Survival Rate
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Summary:	Background Non‐alcoholic steatohepatitis (NASH) and cryptogenic cirrhosis (CC) are increasing indications for orthotopic liver transplantation (OLT). The aim of this study is to describe our outcomes and delineate predictors of recurrence of NASH and CC after OLT. Methods This is a retrospective study from 1996 to 2008. Donor and recipient demographics, metabolic profile, insulin and steroid intake, immunosuppression regimen, operative factors, outcomes, and pathologies were reviewed. Fisher's exact test, Cox regression models, and Kaplan–Meier plots were used. Results A total of 83 patients were included. Recurrence occurred in 20 patients. Thirty‐four percent of the patients with metabolic syndrome (MS) had recurrence of NASH or CC compared with 13% of the patients without MS (p = 0.05). Recurrence also occurred in 32% of the patients with hypertension (HTN) vs. 12% in those without HTN (p = 0.05). Thirty‐seven percent of those on insulin had recurrence vs. 6% of those not on insulin (p = 0.05). Five‐yr survival probability for patients with MS, HTN, and insulin use was 52%, 61%, and 58%, respectively. Conclusions Higher recurrence of NASH and CC was associated with presence of MS, HTN and insulin use. Recurrence should be further evaluated in larger studies, with special emphasis on management of MS and prevention strategies.
Bibliography:	ark:/67375/WNG-14WLMSHC-2 istex:7A8E9019B66D29E466F714FFD2D369521DD30781 ArticleID:CTR12014 Conflict of interest: The authors have no conflict of interest to declare. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0902-0063 1399-0012
DOI:	10.1111/ctr.12014