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Pre-transplant NASH predicts cardiovascular events post-transplant
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SAN DIEGO — Pre-transplant diagnosis of nonalcoholic steatohepatitis predicted cardiovascular disease but not poorer survival in the post-liver transplantation setting, according to findings presented at Digestive Diseases Week 2016.
Praveena Narayanan, of the Mayo Medical School in Rochester, Minn., and colleagues noted that NAFLD and NASH are predictive of cardiovascular disease in the general population. “In the post-transplant setting, complications such as obesity, metabolic syndrome and cardiovascular disease are more common than in the general population,” she said. The aim of the study was to determine the frequency and impact of NASH and allograft steatosis — as defined by imaging only — on long-term outcomes after liver transplantation.
“We separated de novo and recurrent NAFLD, as we believe they are two different clinical entities,” Narayanan said.
The analysis included 588 liver transplant recipients accrued between 1999 and 2006. Endpoints were patient survival, graft survival and cardiovascular disease, which included cardiac arrest, myocardial infarction, unstable angina, chronic heart failure, arrhythmia, stroke and peripheral vascular disease.
The mean patient age was 51.9 ± 10.6 years, while the BMI was 27.5 ± 5.9, and the MELD score was 18.8 ± 7.9. Previous tobacco use was reported in 52% of the cohort, while 30.3% had diabetes before transplantation, 23.2% had hypertension and 14.8% had prior cardiovascular disease.
The current data set includes 34 patients with NASH and 554 patients without NASH.
Allograft steatosis occurred in 180 transplant recipients, according to Narayanan.
Results indicated a 10-year rate of allograft steatosis of 72.4% in the NASH group, compared with 31.6% of those in the non-NASH group.
Univariate analysis results indicated that BMI, diabetes, hypertension and NASH predicted allograft steatosis in the transplant setting. In multivariable analysis, BMI was the only factor that predicted allograft steatosis.
No association was reported between allograft steatosis and post-liver transplantation survival (P = .292), according to the findings. Underlying NASH also did not predict survival after transplant (P = .063).
“Survival outcomes showed a non-significant trend toward better survival in patients with NASH,” Narayanan said. “The development of allograft steatosis did not significantly impact survival at 1 year.
The 10-year cardiovascular event rate was 56.8% in patients transplanted for NASH and 32.3% for those without NASH, and NASH was an independent risk predictor of cardiovascular events after transplant, whereas allograft steatosis was not, she added.
“The[KDW1] frequency of allograft steatosis by imaging was significantly higher among patients who underwent liver transplantation for NASH than among patients transplanted for other reasons,” Narayanan said. “Risk factors for allograft steatosis include metabolic syndrome and pre-transplantation NASH. Patient and graft survival were not affected by allograft steatosis or NASH.”
For more information:
Narayanan P, et al. Abstract 425. Presented at: Digestive Diseases Week; May 21-24, 2016; San Diego, CA.
Disclosures: Narayanan reports no relevant financial disclosures.
Editor's Note: This has been updated with clarifications from the presenter.