CHAPEL HILL – Non-alcoholic 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 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 said 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 said. “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 said.
Barritt presented these findings on Sunday, May 2, at the annual Digestive Disease Week conference in New Orleans.
In the study, Barritt and study co-authors analyzed data from the cases of 118 liver transplants performed at UNC Hospitals from 2004 to 2007. Of these patients, 21 (18 percent) were transplanted because of NAFLD. In addition, 28 percent of the 118 had diabetes, 29 percent had high blood pressure, 13 percent had high cholesterol and 4 percent 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 percent of the NAFLD patients were still alive, compared to 97 percent of the non-NAFLD patients. One year after transplant, 76 percent of NAFLD patients were still alive compared to 90 percent of non-NAFLD patients. Three years after transplant, the difference was 76 percent survival among NAFLD patients and 84 percent survival in the non-NAFLD group. Overall, NAFLD patients had a 9 times greater rate of death at 30 days after transplant compared to non-NAFLD patients. The rate of death was higher at 1 and 3 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 said. “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.”
Study co-authors, all from the UNC School of Medicine, include Evan S. Dellon, MD, MPH; Tomasz Kozlowski, MD; David A. Gerber, MD; and senior author Paul H. Hayashi, MD, MPH.
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