Liver Transplantation for Nonalcoholic Steatohepatitis The New Epidemic

被引：190

作者：

Agopian, Vatche G. ^{[3
]}

Kaldas, Fady M. ^{[3
]}

Hong, Johnny C. ^{[3
]}

Whittaker, Meredith ^{[3
]}

Holt, Curtis ^{[3
]}

Rana, Abbas ^{[3
]}

Zarrinpar, Ali ^{[3
]}

Petrowsky, Henrik ^{[3
]}

Farmer, Douglas ^{[3
]}

Yersiz, Hasan ^{[3
]}

Xia, Victor ^{[2
]}

Hiatt, Jonathan R. ^{[3
]}

Busuttil, Ronald W. ^{[1
,3
]}

机构：

[1] Univ Calif Los Angeles, David Geffen Sch Med, Div Liver & Pancreas Transplantat,Dept Surg, Dumont UCLA Transplant Ctr,Pfleger Liver Inst, Los Angeles, CA 90095 USA

[2] Univ Calif Los Angeles, David Geffen Sch Med, Dept Anesthesiol, Los Angeles, CA 90095 USA

[3] Pfleger Liver Inst, Dumont UCLA Liver Canc Ctr, Dept Surg, Los Angeles, CA USA

来源：

ANNALS OF SURGERY | 2012年 / 256卷 / 04期

关键词：

liver transplantation; metabolic syndrome; nonalcoholic fatty liver disease; nonalcoholic steatohepatitis; BODY-MASS INDEX; LONG-TERM OUTCOMES; LENGTH-OF-STAY; FATTY LIVER; METABOLIC SYNDROME; CRYPTOGENIC CIRRHOSIS; UNITED-STATES; RESOURCE UTILIZATION; RENAL DYSFUNCTION; MEDICAL PROGRESS;

D O I：

10.1097/SLA.0b013e31826b4b7e

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Objective: To analyze incidence, outcomes, and utilization of health care resources in liver transplantation (LT) for nonalcoholic steatohepatitis (NASH). Summary of Background Data: With the epidemic of obesity and metabolic syndrome in nearly 33% of the US population, NASH is projected to become the leading indication for LT in the next several years. Data on predictors of outcome and utilization of health care resources after LT in NASH is limited. Methods: We conducted an analysis from our prospective database of 144 adult NASH patients who underwent LT between December 1993 and August 2011. Outcomes and resource utilization were compared with other common indications for LT. Independent predictors of graft and patient survival were identified. Results: The average Model for End-Stage Liver Disease score was 33. The frequency of NASH as the primary indication for LT increased from 3% in 2002 to 19% in 2011 to become the second most common indication for LT at our center behind hepatitis C. NASH patients had significantly longer operative times (402 vs 322 minutes; P < 0.001), operative blood loss (18 vs 14 packed red blood cell units; P = 0.001), and posttransplant length of stay (35 vs 29 days; P = 0.032), but 1-, 3-, and 5-year graft (81%, 71%, 63%) and patient (84%, 75%, 70%) survival were comparable with other diagnoses. Age greater than 55 years, pretransplant intubation, dialysis, hospitalization, presence of hepatocellular carcinoma on explant, donor age greater than 55 years, and cold ischemia time greater than 550 minutes were significant independent predictors of survival for all patients, whereas body mass index greater than 35 was a predictor in NASH patients only. Conclusions: We report the largest single institution experience of LT for NASH. Over a 10-year period, the frequency of LT for NASH has increased 5-fold. Although outcomes are comparable with LT for other indications, health care resources are stressed significantly by this new and increasing group of transplant candidates.

引用

页码：624 / 633

页数：10

共 48 条

[21] Diagnosis and management of the metabolic syndrome - An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement [J].