Alcohol Use and Transplant Survival Rates

(Ivanhoe Newswire) – There is no statistical difference in post-transplant survival rates for patients who received liver transplants for nonalcoholic steatohepatitis (NASH) compared with those who received transplants for alcoholic liver disease (ETOH).

NASH affects 2 to 5 percent of Americans and ranks as one of the major causes of cirrhosis in the U.S., behind hepatitis C and alcoholic liver disease. Incidences of both NASH and nonalcoholic fatty liver disease are increasing, possibly because of the growing number of obesity cases. Obesity also contributes to diabetes and high blood cholesterol, which can further complicate the health of someone with NASH.

NASH is often a "silent" liver disease and can lead to cirrhosis and permanent liver damage before symptoms occur. Once serious scarring or cirrhosis is present, few treatments can halt the progression. Liver transplantation remains the only treatment for advanced cirrhosis with liver failure and is increasingly performed in people with NASH.

Vishal Bhagat, M.D, and colleagues at the University of Miami demonstrated that liver transplant is an appropriate treatment for NASH patients, with survival rates comparable to those for ETOH patients. The team reviewed all patients who underwent liver transplant for cryptogenic cirrhosis with NASH phenotype and alcoholic cirrhosis at the University of Miami from January 1997 through January 2007.

Cryptogenic cirrhosis was defined by absence of significant alcohol use, negative tests for viral hepatitis, negative autoimmune markers, and negative markers for hemochromatosis, Wilson disease and alpha-1 antitrypsin deficiency.

The alcoholic cirrhosis (ETOH) group included patients who had history of significant alcohol consumption, had no biochemical, serological and histological evidence of other known causes of cirrhosis, and underwent liver transplant from January 1997 through January 2007.

"Our study presents the largest patient population with the longest follow-up published so far on the survival of patients with NASH cirrhosis," Dr. Bhagat was quoted as saying. "We found that although there was a trend towards lower patient survival in the NASH group compared with the ETOH group, the difference was not statistically significant."

In both the NASH and ETOH groups, sepsis was the most common cause of death post-liver transplant, followed by cardiovascular causes in the NASH group and malignancies in the ETOH group.

"Cardiovascular mortality among NASH patients was much higher than published autopsy results in liver transplant patients and stresses the importance of control of the metabolic syndrome post-transplant in NASH patients," added Dr. Bhagat.

SOURCE: Liver Transplantation, December 2009

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