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Multicenter Study
. 2022 Nov;42(11):2428-2441.
doi: 10.1111/liv.15385. Epub 2022 Aug 25.

Liver transplantation for NAFLD cirrhosis: Age and recent coronary angioplasty are major determinants of survival

François Villeret  1   2 , Sébastien Dharancy  3 , Domitille Erard  1   2 , Armand Abergel  4 , Louise Barbier  5 , Camille Besch  6 , Olivier Boillot  2   7 , Karim Boudjema  8 , Audrey Coilly  9 , Filomena Conti  10 , Christophe Corpechot  11 , Christophe Duvoux  12 , François Faitot  6 , Stéphanie Faure  13 , Claire Francoz  14 , Emiliano Giostra  15 , Jean Gugenheim  16 , Jean Hardwigsen  17 , Marie-Noëlle Hilleret  18 , Jean-Baptiste Hiriart  19 , Pauline Houssel-Debry  8 , Nassim Kamar  20 , Guillaume Lassailly  3 , Marianne Latournerie  21 , Georges-Philippe Pageaux  13 , Didier Samuel  9 , Claire Vanlemmens  22 , Faouzi Saliba  9 , Jérôme Dumortier  2   7
Affiliations
Multicenter Study

Liver transplantation for NAFLD cirrhosis: Age and recent coronary angioplasty are major determinants of survival

François Villeret et al. Liver Int. 2022 Nov.

Abstract

Background and aims: Liver transplantation (LT) is the treatment of end-stage non-alcoholic liver disease (NAFLD), that is decompensated cirrhosis and/or complicated by hepatocellular carcinoma (HCC). Few data on long-term outcome are available. The aim of this study was to evaluate overall patient and graft survivals and associated predictive factors.

Method: This retrospective multicentre study included adult transplant patients for NAFLD cirrhosis between 2000 and 2019 in participating French-speaking centres.

Results: A total of 361 patients (69.8% of male) were included in 20 centres. The median age at LT was 62.3 years [57.4-65.9] and the median MELD score was 13.9 [9.1-21.3]; 51.8% of patients had HCC on liver explant. Between 2004 and 2018, the number of LT for NAFLD cirrhosis increased by 720%. A quarter of the patients had cardiovascular history before LT. Median follow-up after LT was 39.1 months [15.8-72.3]. Patient survival at 1, 5 and 10 years after LT was 89.3%, 79.8% and 68.1% respectively. The main causes of death were sepsis (37.5%), malignancies (29.2%) and cardiovascular events (22.2%). In multivariate analysis, three risk factors for overall mortality after LT were recipient pre-LT BMI < 32 kg/m2 at LT time (OR: 2.272; p = .012), pre-LT angioplasty during CV check-up (OR: 2.916; p = .016), a combined donor and recipient age over 135 years (OR: 2.020; 95%CI: p = .035).

Conclusion: Survival after LT for NAFLD cirrhosis is good at 5 years. Donor and recipient age, and cardiovascular history, are major prognostic factors to consider.

Keywords: NAFLD; liver transplantation; metabolic syndrome; survival.

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Conflict of interest statement

No conflict of interest to declare for all authors.

Figures

FIGURE 1
FIGURE 1
Evolution of Patients transplanted for NAFLD cirrhosis in France and Geneva between 2001 and 2019.
FIGURE 2
FIGURE 2
Graft (A) and overall patient (B) survival (According to Kaplan–Meier estimates). (A) Graft survival at 1, 5 and 10 years after was 86.8%, 77.2% and 65.3% respectively. (B) Patient survival at 1, 5 and 10 years after LT was 89.3%, 79.8% and 68.1% respectively.
FIGURE 3
FIGURE 3
Characteristics of deaths after LT according to the period: before 6 months (A) and after 6 months (B) Median delay from LT (range).
FIGURE 4
FIGURE 4
Patient overall survival according to three independent prognostic factors: BMI ≥32 kg/m2 at LT time (A), combined recipient and donor age ≥ 135 years (B) and pre‐LT angioplasty (C). (According to Kaplan–Meier estimates). (A) Patient survival according to BMI at LT time (greater than or equal to 32 kg/m2). Patient survival at 1, 5 and 10 years was 92.6%, 87.2% and 77.8%, respectively, in the group with a BMI greater than 32 kg/m2. In the group with a BMI less than 32 kg/m2, patient survival was 86.8%, 75.5% and 61.6% at 1, 5 and 10 years respectively (p = .003). (B) Patient survival according to the presence of history of pre‐LT angioplasty. In patients without angioplasty during CV check‐up before LT, survival was 90.2%, 81.9% and 71.9% at 1, 5 and 10 years respectively. In patient with a history of pre‐LT angioplasty, survival was 71.9% at 1 year, 51.1% at 5 years and 38.3% at 10 years (p = .003). (C) Patient survival according to the combined recipients and donors age at LT time. In the group with a combined age less than 135 years, patient survival was 93.3% at 1 year, 84.8% at 5 years and 74.5% at 10 years. In the group with a combined age greater than 135 years, patient survival at 1, 5 and 10 years was, respectively, 83.3%, 75.9% and 54.7% (p = .035).
FIGURE 5
FIGURE 5
Patient survival after LT according to the absence or presence of one or more risk factors. (According to Kaplan–Meier estimates). Risk factors considered for analysis: BMI less than 32 kg/m2, pre‐LT angioplasty and combined donor and recipient age greater than 135 years. In the group of patients without risk factors, patient survival was 93.0% at 1 year, 85.9% at 5 years and 73.7% at 10 years. With risk factors, patient survival was 82.2%, 71.1% and 51.8% at 1, 5 and 10 years respectively. The difference is significant between the two groups of patients (p = .005).
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