Magnus Holmer1,2, Espen Melum3,4,5, Helena Isoniemi6, Bo-Göran Ericzon7, Maria Castedal8, Arno Nordin6, Nicolai Aagaard Schultz9, Allan Rasmussen9, Pål-Dag Line10,11, Per Stål1,2, William Bennet8, Hannes Hagström1,2. 1. Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden. 2. Division of Hepatology, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden. 3. Division of Surgery, Inflammatory Diseases and Transplantation, Section for Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway. 4. Division of Surgery, Inflammatory Diseases and Transplantation, Department of Transplantation Medicine, Norwegian PSC Research Center, Oslo University Hospital Rikshospitalet, Oslo, Norway. 5. Division of Surgery, Inflammatory Diseases and Transplantation, Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway. 6. Department of Transplantation and Liver Surgery, University Hospital, Helsinki, Finland. 7. Division of Transplantation Surgery, Karolinska Institutet, CLINTEC, Stockholm, Sweden. 8. Transplant Institute, Sahlgrenska University Hospital, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. 9. Department of Surgical Gastroenterology and Liver Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 10. Division of Surgery, Inflammation Medicine and Transplantation, Section for Transplantation surgery, Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway. 11. Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Abstract
BACKGROUND & AIMS: Nonalcoholic fatty liver disease(NAFLD) is the second most common cause of liver transplantation in the US. Data on NAFLD as a liver transplantation indication from countries with lower prevalences of obesity are lacking. We studied the temporal trends of NAFLD as an indication for liver transplantation in the Nordic countries, and compared outcomes for patients with NAFLD to patients with other indications for liver transplantation. METHOD: Population-based cohort study using data from the Nordic Liver Transplant Registry on adults listed for liver transplantation between 1994 and 2015. NAFLD as the underlying indication for liver transplantation was defined as a listing diagnosis of NAFLD/nonalcoholic steatohepatitis, or cryptogenic cirrhosis with a body mass index ≥25 kg/m2 and absence of other liver diseases. Waiting time for liver transplantation, mortality and withdrawal from the transplant waiting list were registered. Survival after liver transplantation was calculated using multivariable Cox regression, adjusted for age, sex, body mass index and model for end-stage liver disease. RESULTS: A total of 4609 patients listed for liver transplantation were included. NAFLD as the underlying indication for liver transplantation increased from 2.0% in 1994-1995 to 6.2% in 2011-2015 (P = .01) and was the second most rapidly increasing indication. NAFLD patients had higher age, model for end-stage liver disease and body mass index when listed for liver transplantation, but overall survival after liver transplantation was comparable to non--NAFLD patients (aHR 1.03, 95% CI 0.70-1.53 P = .87). CONCLUSION: NAFLD is an increasing indication for liver transplantation in the Nordic countries. Despite more advanced liver disease, NAFLD patients have a comparable survival to other patients listed for liver transplantation.
BACKGROUND & AIMS:Nonalcoholic fatty liver disease(NAFLD) is the second most common cause of liver transplantation in the US. Data on NAFLD as a liver transplantation indication from countries with lower prevalences of obesity are lacking. We studied the temporal trends of NAFLD as an indication for liver transplantation in the Nordic countries, and compared outcomes for patients with NAFLD to patients with other indications for liver transplantation. METHOD: Population-based cohort study using data from the Nordic Liver Transplant Registry on adults listed for liver transplantation between 1994 and 2015. NAFLD as the underlying indication for liver transplantation was defined as a listing diagnosis of NAFLD/nonalcoholic steatohepatitis, or cryptogenic cirrhosis with a body mass index ≥25 kg/m2 and absence of other liver diseases. Waiting time for liver transplantation, mortality and withdrawal from the transplant waiting list were registered. Survival after liver transplantation was calculated using multivariable Cox regression, adjusted for age, sex, body mass index and model for end-stage liver disease. RESULTS: A total of 4609 patients listed for liver transplantation were included. NAFLD as the underlying indication for liver transplantation increased from 2.0% in 1994-1995 to 6.2% in 2011-2015 (P = .01) and was the second most rapidly increasing indication. NAFLD patients had higher age, model for end-stage liver disease and body mass index when listed for liver transplantation, but overall survival after liver transplantation was comparable to non--NAFLD patients (aHR 1.03, 95% CI 0.70-1.53 P = .87). CONCLUSION: NAFLD is an increasing indication for liver transplantation in the Nordic countries. Despite more advanced liver disease, NAFLD patients have a comparable survival to other patients listed for liver transplantation.
Authors: Debashis Haldar; Barbara Kern; James Hodson; Matthew James Armstrong; Rene Adam; Gabriela Berlakovich; Josef Fritz; Benedikt Feurstein; Wolfgang Popp; Vincent Karam; Paolo Muiesan; John O'Grady; Neville Jamieson; Stephen J Wigmore; Jacques Pirenne; Seyed Ali Malek-Hosseini; Ernest Hidalgo; Yaman Tokat; Andreas Paul; Johann Pratschke; Michael Bartels; Pavel Trunecka; Utz Settmacher; Massimo Pinzani; Christophe Duvoux; Philip Noel Newsome; Stefan Schneeberger Journal: J Hepatol Date: 2019-05-07 Impact factor: 25.083