Z Gastroenterol 2016; 54 - P10
DOI: 10.1055/s-0036-1583988

NASH cirrhosis as an increasing cause for liver transplantation – the Viennese experience

LW Unger 1, M Herac 2, T Reiberger 3, KA Staufer 1, A Salat 1, G Silberhumer 1, M Hofmann 1, M Trauner 3, S Rasoul-Rockenschaub 1, T Soliman 1, G Berlakovich 1
  • 1Medical University of Vienna/General Hospital of Vienna/Dept. of Surgery/Division of Transplantation, Vienna, Austria
  • 2Medical University of Vienna/General Hospital of Vienna/Clin. Inst. of Pathology, Vienna, Austria
  • 3Medical University of Vienna/General Hospital of Vienna/Dept. of Internal Medicine III, Vienna, Austria

Background: Non-alcoholic steatohepatitis (NASH) represents the hepatic manifestation of the metabolic syndrome and can ultimately lead to liver cirrhosis. Since the global prevalence of the metabolic syndrome is increasing, NASH cirrhosis has become a leading cause for orthotopic liver transplantation (OLT). NASH recurrence may be observed after transplantation, not only due to host factors but also due to immunosuppressive therapy's side-effects. Some cases of NASH might have been misclassified as cryptogenic cirrhosis (CC) in the past, while the awareness for NASH cirrhosis has increased in recent years. Here we aimed to evaluate explant histology and the clinical course after OLT for CC versus NASH cirrhosis.

Methods: Patients listed for CC/NASH and transplanted between 01.01.2004 and 30.09.2015 were included. Histological NAS score and the noninvasive NAFLD fibrosis score were calculated. Laboratory parameters and clinical course were assessed for 24 months after OLT.

Results: 2/14 patients (14.3%) who had been listed for CC were re-classified as NASH. Finally, 15 and 12 patients were transplanted due to NASH and CC, respectively. The numbers of patients undergoing OLT were increasing for NASH (n = 2 in 2004 – 2007 to n = 9 in 2012 – 2015) while decreasing for CC (n = 6 in 2004 – 2007 to n = 2 in 2012 – 2015). Patient characteristics at OLT were similar between groups, except for an older age and a higher body mass index in NASH patients (59.1 (± 2.2) vs. 51.8 (± 2.9) years, p = 0.05; 27.7 (± 1.2)kg/m2 vs. 24.3 (± 0.8)kg/m2, p = 0.0347). Although post-OLT plasma lipid levels and incidence of de-novo hypertension, diabetes and hyperlipidemia were similar between groups, NAFLD fibrosis score increased significantly in the NASH group (but not for CC) at 6 months after OLT.

Conclusion: According to the NAFLD fibrosis score, significant fibrosis seems to re-occur as early as 6 months after OLT in patients with NASH – indicating that recurrent NASH will emerge as a clinical management priority after transplantation.