Liver transplantation for <scp>NAFLD</scp> cirrhosis: Age and recent coronary angioplasty are major determinants of survival - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Liver International Année : 2022

Liver transplantation for NAFLD cirrhosis: Age and recent coronary angioplasty are major determinants of survival

François Villeret
Armand Abergel
Louise Barbier
Olivier Boillot
Christophe Duvoux
Claire Francoz
Jérôme Dumortier

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
Fichier principal
Vignette du fichier
LIV-42-2428.pdf (1.32 Mo) Télécharger le fichier
Origine Fichiers éditeurs autorisés sur une archive ouverte

Dates et versions

hal-04165914 , version 1 (19-07-2023)

Licence

Identifiants

Citer

François Villeret, Sébastien Dharancy, Domitille Erard, Armand Abergel, Louise Barbier, et al.. Liver transplantation for NAFLD cirrhosis: Age and recent coronary angioplasty are major determinants of survival. Liver International, 2022, 42, pp.2428 - 2441. ⟨10.1111/liv.15385⟩. ⟨hal-04165914⟩
28 Consultations
13 Téléchargements

Altmetric

Partager

Gmail Mastodon Facebook X LinkedIn More