PDF(Pubmed)
Abstract：
UNASSIGNED: Liver transplantation (LT) is the only available treatment for end-stage non-alcoholic fatty liver disease (NAFLD) (related decompensated cirrhosis and/or hepatocellular carcinoma). The aim of our study was to evaluate the risk of disease recurrence after LT and the factors influencing it.
UNASSIGNED: This retrospective multicenter study included adults transplanted for NAFLD cirrhosis between 2000 and 2019 in 20 participating French-speaking centers. Disease recurrence (steatosis, steatohepatitis and fibrosis) was diagnosed from liver graft biopsies.
UNASSIGNED: We analyzed 150 patients with at least one graft liver biopsy available ≥6 months after transplantation, among 361 patients transplanted for NAFLD. The median (IQR) age at LT was 61.3 (54.4-64.6) years. The median follow-up after LT was 4.7 (2.8-8.1) years. The cumulative recurrence rates of steatosis and steatohepatitis at 5 years were 80.0% and 60.3%, respectively. Significant risk factors for steatohepatitis recurrence in multivariate analysis were recipient age at LT <65 years (odds ratio [OR] 4.214; p = 0.044), high-density lipoprotein-cholesterol <1.15 mmol/L after LT (OR 3.463; p = 0.013) and grade ≥2 steatosis on the graft at 1 year after LT (OR 10.196; p = 0.001). The cumulative incidence of advanced fibrosis (F3-F4) was 20.0% at 5 years after LT and significant risk factors from multivariate analysis were metabolic syndrome before LT (OR 8.550; p = 0.038), long-term use of cyclosporine (OR 11.388; p = 0.031) and grade ≥2 steatosis at 1 year after LT (OR 10.720; p = 0.049). No re-LT was performed for NAFLD cirrhosis recurrence.
UNASSIGNED: Our results strongly suggest that recurrence of initial disease after LT for NAFLD is inevitable and progressive in a large proportion of patients; the means to prevent it remain to be further evaluated.
UNASSIGNED: Non-alcoholic fatty liver disease (NAFLD) is a growing indication for liver transplantation, but the analysis of disease recurrence, based on graft liver biopsies, has been poorly studied. Cumulative incidences of steatosis, steatohepatitis and NAFLD-related significant fibrosis recurrence at 5 years were 85.0%, 60.3% and 48.0%, respectively. Grade ≥2 steatosis on graft biopsy at 1 year (present in 25% of patients) is highly predictive of recurrence of steatohepatitis and advanced fibrosis: bariatric surgery should be discussed in these patients specifically.
UNASSIGNED: This retrospective multicenter study included adults transplanted for NAFLD cirrhosis between 2000 and 2019 in 20 participating French-speaking centers. Disease recurrence (steatosis, steatohepatitis and fibrosis) was diagnosed from liver graft biopsies.
UNASSIGNED: We analyzed 150 patients with at least one graft liver biopsy available ≥6 months after transplantation, among 361 patients transplanted for NAFLD. The median (IQR) age at LT was 61.3 (54.4-64.6) years. The median follow-up after LT was 4.7 (2.8-8.1) years. The cumulative recurrence rates of steatosis and steatohepatitis at 5 years were 80.0% and 60.3%, respectively. Significant risk factors for steatohepatitis recurrence in multivariate analysis were recipient age at LT <65 years (odds ratio [OR] 4.214; p = 0.044), high-density lipoprotein-cholesterol <1.15 mmol/L after LT (OR 3.463; p = 0.013) and grade ≥2 steatosis on the graft at 1 year after LT (OR 10.196; p = 0.001). The cumulative incidence of advanced fibrosis (F3-F4) was 20.0% at 5 years after LT and significant risk factors from multivariate analysis were metabolic syndrome before LT (OR 8.550; p = 0.038), long-term use of cyclosporine (OR 11.388; p = 0.031) and grade ≥2 steatosis at 1 year after LT (OR 10.720; p = 0.049). No re-LT was performed for NAFLD cirrhosis recurrence.
UNASSIGNED: Our results strongly suggest that recurrence of initial disease after LT for NAFLD is inevitable and progressive in a large proportion of patients; the means to prevent it remain to be further evaluated.
UNASSIGNED: Non-alcoholic fatty liver disease (NAFLD) is a growing indication for liver transplantation, but the analysis of disease recurrence, based on graft liver biopsies, has been poorly studied. Cumulative incidences of steatosis, steatohepatitis and NAFLD-related significant fibrosis recurrence at 5 years were 85.0%, 60.3% and 48.0%, respectively. Grade ≥2 steatosis on graft biopsy at 1 year (present in 25% of patients) is highly predictive of recurrence of steatohepatitis and advanced fibrosis: bariatric surgery should be discussed in these patients specifically.
摘要：
未经证实：肝移植（LT）是治疗终末期非酒精性脂肪性肝病（NAFLD）（相关失代偿性肝硬化和/或肝细胞癌）的唯一方法。我们研究的目的是评估LT术后疾病复发的风险及其影响因素。
UNASSIGNED：这项回顾性多中心研究包括2000年至2019年在20个参与的法语国家中心移植NAFLD肝硬化的成年人。疾病复发（脂肪变性，脂肪性肝炎和纤维化）是通过肝移植活检诊断的。
UASSIGNED：我们分析了150例患者，在移植后≥6个月进行了至少一次移植肝活检，在361例NAFLD移植患者中。LT时的中位年龄（IQR）为61.3（54.4-64.6）岁。LT后的中位随访时间为4.7（2.8-8.1）年。5年脂肪变性和脂肪性肝炎的累计复发率分别为80.0%和60.3%,分别。多变量分析中脂肪性肝炎复发的重要危险因素是LT<65岁的接受者年龄（比值比[OR]4.214;p=0.044），LT后高密度脂蛋白-胆固醇<1.15mmol/L（OR3.463;p=0.013），LT后1年移植物脂肪变性≥2级（OR10.196;p=0.001）。晚期纤维化（F3-F4）的累积发生率在LT后5年为20.0%，多变量分析的显著危险因素是LT前的代谢综合征（OR8.550;p=0.038），长期使用环孢素(OR11.388;p=0.031)和LT后1年≥2级脂肪变性(OR10.720;p=0.049).未对NAFLD肝硬化复发进行再次LT。
UNASSIGNED：我们的研究结果强烈表明，在大部分患者中，NAFLDLT术后初次疾病的复发是不可避免的和进行性的；预防其的手段仍有待进一步评估。
UnASSIGNED：非酒精性脂肪性肝病（NAFLD）越来越成为肝移植的适应症，但是对疾病复发的分析，基于移植肝活检，研究得很差。脂肪变性的累积发生率，脂肪性肝炎和NAFLD相关的显著纤维化复发在5年为85.0%，60.3%和48.0%，分别。1年移植活检≥2级脂肪变性（25％的患者存在）高度预测脂肪性肝炎和晚期纤维化的复发：应特别讨论这些患者的减肥手术。
UNASSIGNED：这项回顾性多中心研究包括2000年至2019年在20个参与的法语国家中心移植NAFLD肝硬化的成年人。
UASSIGNED：我们分析了150例患者，在移植后≥6个月进行了至少一次移植肝活检，
UNASSIGNED：我们的研究结果强烈表明，在大部分患者中，NAFLDLT术后初次疾病的复发是不可避免的和进行性的；预防其的手段仍有待进一步评估。
UnASSIGNED：非酒精性脂肪性肝病（NAFLD）越来越成为肝移植的适应症，
