Scripties UMCG - Rijksuniversiteit Groningen
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Liver transplantation for cirrhosis secondary to non-alcoholic steatohepatitis is not performed at the expense of major postoperative morbidity

(2016) Douwes, R. (Rianne)

Background: Non-alcoholic steatohepatitis (NASH) is an emerging indication for liver transplantation due to the obesity pandemic. NASH frequently coexists with multiple comorbidities such as type 2 diabetes mellitus (T2DM), cardiovascular disease and the metabolic syndrome(MetS). Recent studies have shown that long-term patient and graft survival of patients transplanted for NASH cirrhosis are comparable to other indications. However, limited data exists about the short-term (procedure- related) complications after transplantation. Therefore, our aim was to investigate whether these patients are at an increased risk of short-term complications following transplantation.
Methods: This is a single centre retrospective cohort study including all adult patients (≥18 years) who underwent liver transplantation between January 2009 and December 2015 (N=224). Exclusion criteria were liver transplantation for acute hepatic failure or non-cirrhotic liver disease. Patients were censored at time of re-transplantation (n=17). Post-operative complications within 90 days were classified according to the Clavien-Dindo classification of surgical complications. NASH was defined by either: 1) histologic evidence of NASH on biopsy or explant; 2) imaging showing hepatic steatosis; 3) a phenotypic diagnosis consisting of BMI ≥ 30 kg/m2 and presence of T2DM (by either HbA1c ≥ 47 mmol/L or glucose lowering medication use) or the presence of at least 3 out of 5 diagnostic criteria for MetS as defined by the NCEP Adult Treatment Panel (ATP III). A p<0.05 was considered significant.
Results: Out of 169 eligible patients, 34 patients (20.1%) were transplanted for NASH cirrhosis. Patients with NASH cirrhosis were significantly older (59.2 vs. 54.8 years, p=0.011), more often obese (BMI≥30 kg/m2) (61.8% vs. 8.1%, p<0.001), had more T2DM (73.5% vs. 20.0%, p<0.001) and were more likely to meet criteria for MetS (83.3% vs. 37.8%, p<0.001). In univariate analysis, this group suffered from more grade I complications (p=0.016) and more grade II urogenital infections (47.1% vs. 20.0%, p=0.001). Major complications as well as 90-day graft survival in both groups was similar.
Conclusion: In patients transplanted for NASH cirrhosis postoperative major morbidity and mortality rates were comparable with patients transplanted for other indications, despite increased (minor) grade I postoperative complications.

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