Background/Aims: Non-alcoholic fatty liver disease (NAFLD) with its progressive form nonalcoholic steatohepatitis (NASH) is the most common chronic liver disease in western countries which is associated with end-stage liver disease and hepatocellular carcinoma (HCC). This entity is a consistently increasing indication for transplantation. However, data about postsurgery outcome and complications are still limited. Patients and Methods: Records of 432 consecutive transplanted patients between October 2007 and January 2011 were investigated retrospectively. Forty transplants were performed due to NASH-induced cirrhosis. Perioperative courses and short- and long-term outcomes were analyzed. Results: The NAFLD population consisted of 16 women and 24 men with a mean age of 55 years. The median MELD score was 27 at the time of liver transplantion. BMI before surgery ranged from 21 to 45 (mean 31). Sixteen of the initial 40 patients are still alive. Patients with sustained obesity and features of the metabolic syndrome had a worse 1-year mortality rate of 42%. Conclusions: A significant number of liver transplantations in our center was performed due to NASH; transplantation in this cohort was associated with high mortality and postoperative complications, most likely due to associated obesity and diabetes. Weight reduction prior to surgery may lead to a better outcome.

1.
Pillai AA, Rinella ME: Non-alcoholic fatty liver disease: is bariatric surgery the answer? Clin Liver Dis 2009;13:689–710.
2.
Wree A, Kahraman A, Gerken G, et al: Obesity affects the liver – the link between adipocytes and hepatocytes. Digestion 2011;83:124–133.
[PubMed]
3.
Caldwell S, Argo C: The natural history of non-alcoholic fatty liver disease. Dig Dis 2010;28:162–168.
[PubMed]
4.
Gami AS, Witt BJ, Howard DE, et al: Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Cardiol 2007;49:403–414.
5.
Buchwald H, Avidor Y, Braunwald E: Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724–1737.
[PubMed]
6.
Charlton MR, Burns JM, Pedersen RA, et al: Frequency and outcomes of liver transplantation for non-alcoholic steatohepatitis in the United States. Gastroenterology 2011; 141:1249–1253.
7.
Afzali A, Berry K, Ioannou GN: Excellent post-transplantation survival in patients with non-alcoholic steatohepatitis in the United States. Liver Transpl 2011;Epub ahead of print.
8.
Bhagat V, Mindikoglu AL, Nudo CG, et al: Outcomes of liver transplantation in patients with cirrhosis due to nonalcoholic steatohepatitis versus patients with cirrhosis due to alcoholic liver disease. Liver Transpl 2009;15:1814–1820.
9.
Abouna GM: Organ shortage crisis: problems and possible solutions. Transplant Proc 2008;40:34–38.
10.
Heuer M, Kaiser GM, Lendemans S, et al: Transplantation after blunt trauma to the liver: a valuable option or a ‘waste of organs’? Eur J Med Res 2010;15:169–173.
11.
NASH Clinical Research Network (CRN); http://www.jhuccs1.us/nash. Nov 2, 2011.
12.
Ertle J, Dechene A, Sowa JP, et al: Non-alcoholic fatty liver disease progresses to hepatocellular carcinoma in the absence of apparent cirrhosis. Int J Cancer 2011;128:2436–2443.
13.
United Network for Organ Sharing (UNOS); http://www.unow.org. Nov 2, 2011.
14.
World Health Organization (WHO); http://www.who.int. Nov 2, 2011.
15.
Weiss KH, Gotthard D, Schmidt J, et al: Liver transplantation for metabolic liver diseases in adults: indications and outcome. Nephrol Dial Transplant 2007;22:9–12.
16.
Adam R, McMaster P, O’Grady JG, et al: Evolution of liver transplantation in Europe: report of the European Liver Transplant Registry. Liver Transpl 2003;9:1231–1243.
[PubMed]
17.
Pomfret EA, Sung RS, Allan J, et al: Solving the organ shortage crisis: the 7th Annual American Society of Transplant Surgeons’ State-of-the-Art Winter Symposium. Am J Transplant 2008;8:745–752.
18.
Burra P, Senzolo M, Adam R, et al: Liver transplantation for alcoholic liver disease in Europe: a study from the ELTR (European Liver Transplant Registry). Am J Transplant 2010;10:138–148.
[PubMed]
19.
Sass DA, Reich DJ: Liver transplantation in the 21st century: expanding the donor options. Gastroenterol Clin North Am 2011;40:641–658.
20.
Rakela J, Lange SM, Ludwig J, et al: Fulminant hepatitis: Mayo Clinic experience with 34 cases. Mayo Clin Proc 1985;60:289–292.
21.
Rakela J, Mosley JW, Edwards VM, et al: A double-blinded, randomized trial of hydrocortisone in acute hepatic failure. The Acute Hepatic Failure Study Group. Dig Dis Sci 1991;36:1223–1228.
[PubMed]
22.
Lewis J, Mohanty S: Non-alcoholic fatty liver disease: a review and update. Dig Dis Sci 2010;55:560–578.
23.
Dowman J, Tomlinson J, Newsome P: Pathogenesis of non-alcoholic fatty liver disease. QJM 2010;103:71–83.
24.
Vuppalanchi R, Chalasani N: Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Selected practical issues in their evaluation and management. Hepatology 2009;49:306–317.
[PubMed]
25.
Malik SM, de Vera ME, Fontes P, et al: Outcome after liver transplantation for NASH cirrhosis. Am J Transplant 2009;9:782–793.
[PubMed]
26.
Contos MJ, Cales W, Sterling RK, et al: Development of non-alcoholic fatty liver disease after orthotopic liver transplantation for cryptogenic cirrhosis. Liver Transpl 2001;7:363–373.
[PubMed]
27.
Nair S, Verma S, Thuluvath PJ: Obesity and its effect on survival in patients undergoing orthotopic liver transplantation in the United States. Hepatology 2002;35:105–109.
28.
Furuya CK Jr, de Oliveira CP, de Mello ES, et al: Effects of bariatric surgery on nonalcoholic fatty liver disease: preliminary findings after 2 years. J Gastroenterol Hepatol 2007;22:510–514.
[PubMed]
29.
Reynolds K, He J: Epidemiology of the metabolic syndrome. Am J Med Sci 2005;330:273–279.
30.
Rubino F: Bariatric surgery: effects on glucose homeostasis. Curr Opin Clin Nutr Metab Care 2006;9:497–507.
31.
Chavez-Tapia NC, Tellez-Avila FI, Barrientos-Gutierrez T, et al: Bariatric surgery for non-alcoholic steatohepatitis in obese patients. Cochrane Database Syst Rev 2010;1:CD007340.
32.
World Health Organization (WHO): Obesity: preventing and managing the global epidemic. Report of WHO Consultation. WHO Health Organ Tech Rep Ser 2000;894:1–253.
You do not currently have access to this content.