Liver transplantation for NAFLD cirrhosis: Age and recent coronary angioplasty are major determinants of survival
Résumé
Background and Aims: Liver transplantation (LT) is the treatment of end-stage nonalcoholic liver disease (NAFLD), that is decompensated cirrhosis and/or complicated by hepatocellular carcinoma (HCC). Few data on long-term outcome are available. The aim of this study was to evaluate overall patient and graft survivals and associated predictive factors. Method: This retrospective multicentre study included adult transplant patients for NAFLD cirrhosis between 2000 and 2019 in participating French-speaking centres. Results: A total of 361 patients (69.8% of male) were included in 20 centres. The median age at LT was 62.3 years [57.4-65.9] and the median MELD score was 13.9 [9.1-21.3]; 51.8% of patients had HCC on liver explant. Between 2004 and 2018, the number of LT for NAFLD cirrhosis increased by 720%. A quarter of the patients had cardiovascular history before LT. Median follow-up after LT was 39.1 months [15.8-72.3]. Patient survival at 1, 5 and 10 years after LT was 89.3%, 79.8% and 68.1% respectively. The main causes of death were sepsis (37.5%), malignancies (29.2%) and cardiovascular events (22.2%). In multivariate analysis, three risk factors for overall mortality after LT were recipient pre-LT BMI < 32 kg/m 2 at LT time (OR: 2.272; p = .012), pre-LT angioplasty during CV checkup (OR: 2.916; p = .016), a combined donor and recipient age over 135 years (OR: 2.020; 95%CI: p = .035). Conclusion: Survival after LT for NAFLD cirrhosis is good at 5 years. Donor and recipient age, and cardiovascular history, are major prognostic factors to consider.
Mots clés
cardiovascular DRI
donor risk index DSE
dobutamine stress echocardiography GFR
glomerular filtration rate HCC
hepatocellular carcinoma HCV
hepatitis C virus HDL-c
High-Density Lipoproteins Cholesterol ICA
invasive coronary angiography IQR
interquartile range LDL-c
Low-Density Lipoproteins LT
liver transplantation MELD
model for end-stage liver disease MDRD
Modification of Diet in Renal Disease MS
metabolic syndrome mTOR-i
m-TOR inhibitor NAFLD
non-alcoholic fatty Liver disease NASH
nonalcoholic steatohepatitis OSAS
Obstructive Sleep Apnoea syndrome TACE
Trans-Arterial Chemo-Embolization TTE
Transthoracic Echocardiography liver transplantation
metabolic syndrome
NAFLD
survival
Coronary Artery Disease
CKD
Chronic Kidney Disease
CNI
calcineurin inhibitor
COPD
Chronic Obstructive Pulmonary Disease
CST
corticosteroid
CV
cardiovascular
DRI
donor risk index
DSE
dobutamine stress echocardiography
GFR
glomerular filtration rate
HCC
hepatocellular carcinoma
HCV
hepatitis C virus
HDL-c
High-Density Lipoproteins Cholesterol
ICA
invasive coronary angiography
IQR
interquartile range
LDL-c
Low-Density Lipoproteins
LT
liver transplantation
MELD
model for end-stage liver disease
MDRD
Modification of Diet in Renal Disease
MS
mTOR-i
m-TOR inhibitor
non-alcoholic fatty Liver disease
NASH
nonalcoholic steatohepatitis
OSAS
Obstructive Sleep Apnoea syndrome
TACE
Trans-Arterial Chemo-Embolization
TTE
CAD
Coronary Artery Disease CKD
Chronic Kidney Disease CNI
calcineurin inhibitor COPD
Chronic Obstructive Pulmonary Disease CST
corticosteroid CV
Domaines
Hépatologie et GastroentérologieOrigine | Fichiers éditeurs autorisés sur une archive ouverte |
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