Clinical-epidemiological characterization of patients with steatotic liver disease associated with metabolic dysfunction prior to transplantation in a fourth level hospital
DOI:
https://doi.org/10.59093/27112330.76Keywords:
fatty liver, liver transplantation, obesity, liver cirrhosis, hepatocellular carcinoma.Abstract
Introduction. Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most frequent chronic liver disease in Western countries, causing increased costs and hospital occupancy. The comprehensive pre-transplant characterization in patients with MASLD is a major question, especially in our setting. The aim of the present study was to perform the clinical-epidemiological characterization of transplanted patients with decompensated liver cirrhosis (LC) or hepatocellular
carcinoma (HCC) associated with MASLD. Methodology. A retrospective, descriptive, cross-sectional observational study was carried out in the Hepatology Department of the Pablo Tobón Uribe Hospital in Medellin, Colombia. Patients over 17 years of age, with a diagnosis of LC or HCC associated with MASLD who were transplanted between 2004 and 2017 were included. Results. We found 84 patients who were transplanted with these characteristics. The mean age of the patients was 59±10.5 with a significantly higher proportion of men over women, reaching almost 70%. Regarding comorbidities, overweight/obesity, arterial hypertension, and type 2 diabetes mellitus were found in 44.1%, 33.3%, and 33.3%, respectively. On the other hand, 14.5%, 33.7%, and 51.8% had Child-Pugh A, B, and C, respectively. The mean MELD score was 18.9±6.26. Regarding complications of cirrhosis, 77.4% of patients developed ascites, 61.9% hepatic encephalopathy, 36.9% upper gastrointestinal tract hemorrhage, and 29.8% spontaneous bacterial peritonitis. Conclusion. The above results showed our experience of liver transplantation in patients with LC and HCC associated with MASLD. A multidisciplinary evaluation should be performed before and after transplantation in these patients, with special emphasis on the management of metabolic dysfunction and its components, including obesity and diabetes mellitus.
Downloads
References
Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, et al. A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2023. https://doi.org/10.1097/hep.0000000000000520.
European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 2016;64:1388-1402. https://doi.org/10.1016/j.jhep.2015.11.004.
Estes C, Anstee QM, Arias-Loste MT, Bantel H, Bellentani S, Caballeria J, et al. Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016-2030. J Hepatol 2018;69:896-904. https://doi.org/10.1016/j.jhep.2018.05.036.
Younossi ZM. Non-alcoholic fatty liver disease-A global public health perspective. J Hepatol 2019;70:531-544. https://doi.org/10.1016/j.jhep.2018.10.033.
Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016;64:73-84. https://doi.org/10.1002/hep.28431.
Noureddin M, Vipani A, Bresee C, Todo T, Kim IK, Alkhouri N, et al. NASH leading cause of liver transplant in women: Updated analysis of indications for liver transplant and ethnic and gender variances. Am J Gastroenterol 2018;113:1649-1659. https://doi.org/10.1038/s41395-018-0088-6.
Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology 2018;67:123-133. https://doi.org/10.1002/hep.29466.
Villeret F, Dharancy S, Erard D, Abergel A, Barbier L, Besch C, et al. Liver transplantation for NAFLD cirrhosis: Age and recent coronary angioplasty are major determinants of survival. Liver Int 2022;42:2428-2441. https://doi.org/10.1111/liv.15385.
Ahn JC, Sundaram V. Obesity and liver decompensation. Clin Liver Dis (Hoboken) 2019;14:12-15. https://doi.org/10.1002/cld.807.
Berzigotti A, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Morillas R, et al. Obesity is an independent risk factor for clinical decompensation in patients with cirrhosis. Hepatology 2011;54:555-561. https://doi.org/10.1002/hep.24418.
Younossi ZM, Stepanova M, Saab S, Kalwaney S, Clement S, Henry L, et al. The impact of type 2 diabetes and obesity on the long-term outcomes of more than 85 000 liver transplant recipients in the US. Aliment Pharmacol Ther 2014;40:686-694. https://doi.org/10.1111/apt.12881.
Burra P, Becchetti C, Germani G. NAFLD and liver transplantation: Disease burden, current management and future challenges. JHEP Rep 2020;2:100192. https://doi.org/10.1016/j.jhepr.2020.100192.
Organ Procurement and Tranplantation Network (OPTN). National data. Overall by organ. Viginia, USA: OPTN. Acceso 9 de noviembre de 2022. Disponible en https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/#.
Younossi ZM, Stepanova M, Ong J, Trimble G, AlQahtani S, Younossi I, et al. Nonalcoholic steatohepatitis is the most rapidly increasing indication for liver transplantation in the United States. Clin Gastroenterol Hepatol 2021;19:580-589.e585. https://doi.org/10.1016/j.cgh.2020.05.064.
Haldar D, Kern B, Hodson J, Armstrong MJ, Adam R, Berlakovich G, et al. Outcomes of liver transplantation for non-alcoholic steatohepatitis: A European Liver Transplant Registry study. J Hepatol 2019;71:313-322. https://doi.org/10.1016/j.jhep.2019.04.011.
Tokodai K, Karadagi A, Kjaernet F, Romano A, Ericzon BG, Nowak G. Characteristics and risk factors for recurrence of nonalcoholic steatohepatitis following liver transplantation. Scand J Gastroenterol 2019;54:233-239. https://doi.org/10.1080/00365521.2019.1577484.
Molnar MZ, Joglekar K, Jiang Y, Cholankeril G, Abdul MKM, Kedia S, et al. Association of pretransplant renal function with liver graft and patient survival after liver transplantation in patients with nonalcoholic steatohepatitis. Liver Transpl 2019;25:399-410. https://doi.org/10.1002/lt.25367.
Arun J, Clements RH, Lazenby AJ, Leeth RR, Abrams GA. The prevalence of nonalcoholic steatohepatitis is greater in morbidly obese men compared to women. Obes Surg 2006;16:1351-1358. https://doi.org/10.1381/096089206778663715.
Powell EE, Wong VW, Rinella M. Non-alcoholic fatty liver disease. Lancet 2021;397:2212-2224. https://doi.org/10.1016/s0140-6736(20)32511-3.
Taylor RS, Taylor RJ, Bayliss S, Hagström H, Nasr P, Schattenberg JM, et al. Association between fibrosis stage and outcomes of patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis. Gastroenterology 2020;158:1611-1625. https://doi.org/10.1053/j.gastro.2020.01.043.
Park KH, Son HJ, Choi YJ, Park GH, Lee YS, Park JY, et al. Liver transplant patients with high preoperative serum bilirubin levels are at increased risk of postoperative delirium: A retrospective study. J Clin Med 2020;9:1591. https://doi.org/10.3390/jcm9051591.
Klein KB, Stafinski TD, Menon D. Predicting survival after liver transplantation based on pre-transplant MELD score: a systematic review of the literature. PLoS One 2013;8:e80661. https://doi.org/10.1371/journal.pone.0080661.
Bleszynski MS, Punnen S, Desai S, Hussaini T, Marquez V, Yoshida EM, et al. Outcomes of liver transplant recipients with high MELD scores: an experience from a Canadian centre. Can J Surg 2022;65:E425-e439. https://doi.org/10.1503/cjs.025520.
Santos O, Londoño M, Marín J, Muñoz O, Mena Á, Guzmán C, et al. An experience of liver transplantation in Latin America: a medical center in Colombia. Colomb Med 2015;46:8-13.
Morales-Ortiz AF, Luján-Ramos MA, Donado-Gómez JH, Marín-Zuluaga JI. Comparación entre dos esquemas de inmunosupresión en pacientes con trasplante hepático en un hospital universitario en Medellín, Colombia. Hepatología 2020;1:145-156. https://doi.org/10.52784/27112330.122.
Santos Ó, Muñoz O, Marín JI, Restrepo. JC. Trasplante hepático en un centro de Colombia: comparación de dos períodos. Rev Col Gastroenterol 2019;34:117-124. https://doi.org/10.22516/25007440.391.
Abbott WJ, Thomson A, Steadman C, Gatton ML, Bothwell C, Kerlin P, et al. Child-Pugh class, nutritional indicators and early liver transplant outcomes. Hepatogastroenterology 2001;48:823-827.
Guo Z, He X, Wu L, Ju W, Hu A, Tai Q, et al. Model for end-stage liver disease versus the Child-Pugh score in predicting the post-transplant 3-month and 1-year mortality in a cohort of Chinese recipients. Surg Today 2010;40:38-45. https://doi.org/10.1007/s00595-009-4114-6.
VanWagner LB, Lapin B, Skaro AI, Lloyd-Jones DM, Rinella ME. Impact of renal impairment on cardiovascular disease mortality after liver transplantation for nonalcoholic steatohepatitis cirrhosis. Liver Int 2015;35:2575-2583. https://doi.org/10.1111/liv.12872.
Liu YB, Chen MK. Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions. World J Gastroenterol 2022;28:5910-5930. https://doi.org/10.3748/wjg.v28.i41.5910.
Baiges A, Hernández-Gea V. Management of liver decompensation in advanced chronic liver disease: Ascites, hyponatremia, and gastroesophageal variceal bleeding. Clin Drug Investig 2022;42:25-31. https://doi.org/10.1007/s40261-022-01147-5.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Hepatología
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
La política de reconocimiento de autoría de Hepatología se basa en los criterios indicados por el ICMJE para conferir crédito de un trabajo a una persona, a la vez que se le atribuye responsabilidad por la publicación del mismo.
