Utility and prognostic value of diagnosing MAFLD in patients undergoing liver transplantation for alcohol-related liver disease.
alcohol-related liver disease
liver transplantation
metabolic-dysfunction related liver disease
Journal
Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
revised:
12
02
2023
received:
12
10
2022
accepted:
26
02
2023
medline:
9
6
2023
pubmed:
21
3
2023
entrez:
20
3
2023
Statut:
ppublish
Résumé
Recently, the term metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed to replace non-alcoholic fatty liver disease (NAFLD). This concept enables diagnosing liver disease associated with metabolic dysfunction in patients with alcohol-related liver disease (ALD), a main indication for liver transplantation (LTx). We assessed MAFLD prevalence in ALD patients undergoing LTx and its prognostic value on post-LTx outcomes. We retrospectively analyzed all ALD patients transplanted at our center between 1990 and August 2020. MAFLD was diagnosed based on the presence or history of hepatic steatosis and a BMI > 25 or type II diabetes or ≥ 2 metabolic risk abnormalities at LTx. Overall survival and risk factors for recurrent liver and cardiovascular events were analyzed by Cox regression. Of the 371 included patients transplanted for ALD, 255 (68.7%) had concomitant MAFLD at LTx. Median follow-up post-LTx was 72 months (IQR: 34.50-122). Patients with ALD-MAFLD were older at LTx (p = .001), more often male (p < .001) and more frequently had hepatocellular carcinoma (p < .001). No differences in perioperative mortality and overall survival were found. ALD-MAFLD patients had an increased risk of recurrent hepatic steatosis, irrespective of alcohol relapse, but no superimposed risk of cardiovascular events. The co-presence of MAFLD at LTx for ALD is associated with a distinct patient profile and is an independent risk factor for recurrent hepatic steatosis. The use of MAFLD criteria in ALD patients might increase awareness and treatment of specific hepatic and systemic metabolic abnormalities before and after LTx.
Sections du résumé
BACKGROUND
Recently, the term metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed to replace non-alcoholic fatty liver disease (NAFLD). This concept enables diagnosing liver disease associated with metabolic dysfunction in patients with alcohol-related liver disease (ALD), a main indication for liver transplantation (LTx). We assessed MAFLD prevalence in ALD patients undergoing LTx and its prognostic value on post-LTx outcomes.
METHODS
We retrospectively analyzed all ALD patients transplanted at our center between 1990 and August 2020. MAFLD was diagnosed based on the presence or history of hepatic steatosis and a BMI > 25 or type II diabetes or ≥ 2 metabolic risk abnormalities at LTx. Overall survival and risk factors for recurrent liver and cardiovascular events were analyzed by Cox regression.
RESULTS
Of the 371 included patients transplanted for ALD, 255 (68.7%) had concomitant MAFLD at LTx. Median follow-up post-LTx was 72 months (IQR: 34.50-122). Patients with ALD-MAFLD were older at LTx (p = .001), more often male (p < .001) and more frequently had hepatocellular carcinoma (p < .001). No differences in perioperative mortality and overall survival were found. ALD-MAFLD patients had an increased risk of recurrent hepatic steatosis, irrespective of alcohol relapse, but no superimposed risk of cardiovascular events.
CONCLUSIONS
The co-presence of MAFLD at LTx for ALD is associated with a distinct patient profile and is an independent risk factor for recurrent hepatic steatosis. The use of MAFLD criteria in ALD patients might increase awareness and treatment of specific hepatic and systemic metabolic abnormalities before and after LTx.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14965Informations de copyright
© 2023 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.
Références
Eslam M, Newsome PN, Sarin SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement. J Hepatol. 2020;73(1):202-209. https://doi.org/10.1016/j.jhep.2020.03.039
Eslam M, Sanyal AJ, George J. MAFLD: a consensus-driven proposed nomenclature for metabolic associated fatty liver disease. Gastroenterology. 2020;158(7):1999-2014.e1. https://doi.org/10.1053/j.gastro.2019.11.312
Mendez-Sanchez N, Arrese M, Gadano A, et al. The Latin American Association for the Study of the Liver (ALEH) position statement on the redefinition of fatty liver disease. Lancet Gastroenterol Hepatol. 2021;6(1):65-72. https://doi.org/10.1016/s2468-1253(20)30340-x
Méndez-Sánchez N, Bugianesi E, Gish RG, et al. Global multi-stakeholder endorsement of the MAFLD definition. Lancet Gastroenterol Hepatol. 2022;7(5):388-390. https://doi.org/10.1016/s2468-1253(22)00062-0
Chiang DJ, McCullough AJ. The impact of obesity and metabolic syndrome on alcoholic liver disease. Clin Liver Dis. 2014;18(1):157-163. https://doi.org/10.1016/j.cld.2013.09.006
EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol. 2016;64(2):433-485. https://doi.org/10.1016/j.jhep.2015.10.006
Åberg F, Helenius-Hietala J, Puukka P, Färkkilä M, Jula A. Interaction between alcohol consumption and metabolic syndrome in predicting severe liver disease in the general population. Hepatology. 2018;67(6):2141-2149. https://doi.org/10.1002/hep.29631
Boyle M, Masson S, Anstee QM. The bidirectional impacts of alcohol consumption and the metabolic syndrome: cofactors for progressive fatty liver disease. J Hepatol. 2018;68(2):251-267. https://doi.org/10.1016/j.jhep.2017.11.006
Moreno C, Sheron N, Tiniakos D, Lackner C, Mathurin P. “Dual aetiology fatty liver disease”: a recently proposed term associated with potential pitfalls. J Hepatol. 2021;74(4):979-982. https://doi.org/10.1016/j.jhep.2020.11.004
Hobeika C, Ronot M, Beaufrere A, Paradis V, Soubrane O, Cauchy F. Metabolic syndrome and hepatic surgery. J Visc Surg. 2020;157(3):231-238. https://doi.org/10.1016/j.jviscsurg.2019.11.004
Kennedy C, Redden D, Gray S, et al. Equivalent survival following liver transplantation in patients with non-alcoholic steatohepatitis compared with patients with other liver diseases. HPB (Oxford). 2012;14(9):625-634. https://doi.org/10.1111/j.1477-2574.2012.00497.x
Vanwagner LB, Bhave M, Te HS, Feinglass J, Alvarez L, Rinella ME. Patients transplanted for nonalcoholic steatohepatitis are at increased risk for postoperative cardiovascular events. Hepatology. 2012;56(5):1741-1750. https://doi.org/10.1002/hep.25855
Van Herck J, Verbeek J, van Malenstein H, et al. Liver-related and cardiovascular outcome of patients transplanted for nonalcoholic fatty liver disease: a european single-center study. Transplant Proc. 2021;53(5):1674-1681. https://doi.org/10.1016/j.transproceed.2021.02.025
Saeed N, Glass L, Sharma P, Shannon C, Sonnenday CJ, Tincopa MA. Incidence and risks for nonalcoholic fatty liver disease and steatohepatitis post-liver transplant: systematic review and meta-analysis. Transplantation. 2019;103(11):e345-e354. https://doi.org/10.1097/tp.0000000000002916
Khurmi NS, Chang YH, Eric Steidley D, et al. Hospitalizations for cardiovascular disease after liver transplantation in the United States. Liver Transpl. Oct 2018;24(10):1398-1410. https://doi.org/10.1002/lt.25055
Arab JP, Izzy M, Leggio L, Bataller R, Shah VH. Management of alcohol use disorder in patients with cirrhosis in the setting of liver transplantation. Nat Rev Gastroenterol Hepatol. 2021:1-15. https://doi.org/10.1038/s41575-021-00527-0
Narayanan P, Mara K, Izzy M, et al. Recurrent or de novo allograft steatosis and long-term outcomes after liver transplantation. Transplantation.2019;103(1):e14-e21. https://doi.org/10.1097/tp.0000000000002317
Heinze G, Dunkler D. Five myths about variable selection. Transpl Int. 2017;30(1):6-10. https://doi.org/10.1111/tri.12895
Lin S, Huang J, Wang M, et al. Comparison of MAFLD and NAFLD diagnostic criteria in real world. Liver Int. 2020;40(9):2082-2089. https://doi.org/10.1111/liv.14548
Yamamura S, Eslam M, Kawaguchi T, et al. MAFLD identifies patients with significant hepatic fibrosis better than NAFLD. Liver Int. 2020;40(12):3018-3030. https://doi.org/10.1111/liv.14675
Tsutsumi T, Eslam M, Kawaguchi T, et al. MAFLD better predicts the progression of atherosclerotic cardiovascular risk than NAFLD: generalized estimating equation approach. Hepatol Res. 2021;51(11):1115-1128. https://doi.org/10.1111/hepr.13685
Kim D, Konyn P, Sandhu KK, Dennis BB, Cheung AC, Ahmed A. Metabolic dysfunction-associated fatty liver disease is associated with increased all-cause mortality in the United States. J Hepatol. 2021;75(6):1284-1291. https://doi.org/10.1016/j.jhep.2021.07.035
Ntandja Wandji LC, Gnemmi V, Mathurin P, Louvet A. Combined alcoholic and non-alcoholic steatohepatitis. JHEP Rep. 2020;2(3):100101. https://doi.org/10.1016/j.jhepr.2020.100101
Ioannou GN, Green P, Lowy E, Mun EJ, Berry K. Differences in hepatocellular carcinoma risk, predictors and trends over time according to etiology of cirrhosis. PLoS One. 2018;13(9):e0204412. https://doi.org/10.1371/journal.pone.0204412
Bosch FX, Ribes J, Díaz M, Cléries R. Primary liver cancer: worldwide incidence and trends. Gastroenterology. 2004;127(5 Suppl 1):S5-S16. https://doi.org/10.1053/j.gastro.2004.09.011
Gitto S, Villa E. Non-alcoholic fatty liver disease and metabolic syndrome after liver transplant. Int J Mol Sci. 2016;17(4):490. https://doi.org/10.3390/ijms17040490
Germani G, Laryea M, Rubbia-Brandt L, et al. Management of recurrent and de novo NAFLD/NASH after liver transplantation. Transplantation. 2019;103(1):57-67. https://doi.org/10.1097/tp.0000000000002485