Patients With NAFLD Have Increased Risk for Poor Outcomes After Liver Transplant

Nonalcoholic fatty liver disease (NAFLD) is a bigger risk factor for liver transplant patients than obesity, high blood pressure, and high cholesterol, according to a study by researchers at the University of North Carolina (UNC) at Chapel Hill.

Patients with NAFLD are significantly more likely to die or suffer transplant failure during the first 30 days after transplant than patients without NAFLD. Of the comorbidities frequently associated with NAFLD, namely diabetes, obesity, high blood pressure, and high cholesterol, only diabetes was associated with worse outcomes; diabetes was independently associated with poorer survival at three years after transplant says study lead author A. Sidney Barritt IV, MD, a fellow in advanced hepatology and liver transplant at the UNC School of Medicine.

“NAFLD is a rising epidemic in the field of hepatology and liver transplantation, fueled by the dual epidemics of obesity and diabetes in the United States,” Barritt says. “As NAFLD increases in incidence and prevalence, we expect it to become the leading indication for liver transplant in the next two decades.

“Unfortunately, the same risk factors for NAFLD—diabetes, obesity, high blood pressure and high cholesterol—are also risk factors for heart disease. We are concerned that this group of patients may not be the best candidates for liver transplant,” Barritt says.

In the study, researchers analyzed data from the cases of 118 liver transplants performed at UNC hospitals from 2004 to 2007. Of these patients, 21 (18%) were transplanted because of NAFLD. In addition, 28% of the 118 had diabetes, 29% had high blood pressure, 13% had high cholesterol, and 4% had coronary artery disease.

Among the patients without NAFLD, the reasons given for transplant included hepatitis C (HCV), cirrhosis due to HCV and alcohol consumption, cirrhosis due to alcohol alone, hepatitis B, and other indications such as primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis.

Thirty days after transplant, 81% of the patients with NAFLD were still alive, compared with 97% of the non-NAFLD patients. One year after transplant, 76% of patients with NAFLD were still alive compared with 90% of non-NAFLD patients. Three years after transplant, the difference was 76% survival among patients with NAFLD and 84% survival in the non-NAFLD group. Overall, patients with NAFLD had a nine times greater rate of death at 30 days after transplant compared to non-NAFLD patients. The rate of death was higher at one and three years, but the difference did not reach statistical significance.

“Our findings suggest that patients with NAFLD may need a more thorough assessment before they are put on the transplant waiting list. However, patients with NAFLD will continue to be considered for liver transplant,” Barritt says. “The goal of our research is to find ways to improve transplant outcomes for this population and to ensure that liver transplantation remains a viable, cost effective intervention for all people with liver disease.”

Source: University of North Carolina at Chapel Hill School of Medicine