(Ivanhoe Newswire) – There is no statistical difference in
post-transplant survival rates for patients who received liver transplants
for nonalcoholic steatohepatitis (NASH) compared with those who received
transplants for alcoholic liver disease (ETOH).
NASH affects 2 to 5 percent of Americans and ranks as one of the major
causes of cirrhosis in the U.S., behind hepatitis C and alcoholic liver
disease. Incidences of both NASH and nonalcoholic fatty liver disease are
increasing, possibly because of the growing number of obesity cases. Obesity
also contributes to diabetes and high blood cholesterol, which can further
complicate the health of someone with NASH.
NASH is often a "silent" liver disease and can lead to cirrhosis and
permanent liver damage before symptoms occur. Once serious scarring or
cirrhosis is present, few treatments can halt the progression. Liver
transplantation remains the only treatment for advanced cirrhosis with liver
failure and is increasingly performed in people with NASH.
Vishal Bhagat, M.D, and colleagues at the University of Miami demonstrated
that liver transplant is an appropriate treatment for NASH patients, with
survival rates comparable to those for ETOH patients. The team reviewed all
patients who underwent liver transplant for cryptogenic cirrhosis with NASH
phenotype and alcoholic cirrhosis at the University of Miami from January
1997 through January 2007.
Cryptogenic cirrhosis was defined by absence of significant alcohol use,
negative tests for viral hepatitis, negative autoimmune markers, and
negative markers for hemochromatosis, Wilson disease and alpha-1 antitrypsin
deficiency.
The alcoholic cirrhosis (ETOH) group included patients who had history of
significant alcohol consumption, had no biochemical, serological and
histological evidence of other known causes of cirrhosis, and underwent
liver transplant from January 1997 through January 2007.
"Our study presents the largest patient population with the longest
follow-up published so far on the survival of patients with NASH cirrhosis,"
Dr. Bhagat was quoted as saying. "We found that although there was a trend
towards lower patient survival in the NASH group compared with the ETOH
group, the difference was not statistically significant."
In both the NASH and ETOH groups, sepsis was the most common cause of death
post-liver transplant, followed by cardiovascular causes in the NASH group
and malignancies in the ETOH group.
"Cardiovascular mortality among NASH patients was much higher than published
autopsy results in liver transplant patients and stresses the importance of
control of the metabolic syndrome post-transplant in NASH patients," added
Dr. Bhagat.
SOURCE: Liver Transplantation, December 2009
