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Article Dans Une Revue JHEP Reports Innovation in Hepatology Année : 2023

Inevitability of disease recurrence after liver transplantation for NAFLD cirrhosis

François Villeret
Domitille Erard
  • Fonction : Auteur
Armand Abergel
Louise Barbier
Camille Besch
  • Fonction : Auteur
Olivier Boillot
  • Fonction : Auteur
Filomena Conti
  • Fonction : Auteur
Christophe Corpechot
  • Fonction : Auteur
Christophe Duvoux
  • Fonction : Auteur
François Faitot
  • Fonction : Auteur
Stéphanie Faure
  • Fonction : Auteur
Claire Francoz
  • Fonction : Auteur
Emiliano Giostra
  • Fonction : Auteur
Jean Gugenheim
  • Fonction : Auteur
Jean Hardwigsen
  • Fonction : Auteur
Marie-Noëlle Hilleret
  • Fonction : Auteur
Jean-Baptiste Hiriart
  • Fonction : Auteur
Nassim Kamar
  • Fonction : Auteur
Marianne Latournerie
  • Fonction : Auteur
Georges-Philippe Pageaux
  • Fonction : Auteur
Didier Samuel
  • Fonction : Auteur
Claire Vanlemmens
Faouzi Saliba

Résumé

Background & aims: Liver transplantation (LT) is the only available treatment for end-stage non-alcoholic fatty liver disease (NAFLD) (related decompensated cirrhosis and/or hepatocellular carcinoma). The aim of our study was to evaluate the risk of disease recurrence after LT and the factors influencing it.Method: This retrospective multicenter study included adults transplanted for NAFLD cirrhosis between 2000 and 2019 in 20 participating French-speaking centers. Disease recurrence (steatosis, steatohepatitis and fibrosis) was diagnosed from liver graft biopsies.Results: We analyzed 150 patients with at least one graft liver biopsy available ≥6 months after transplantation, among 361 patients transplanted for NAFLD. The median (IQR) age at LT was 61.3 (54.4-64.6) years. The median follow-up after LT was 4.7 (2.8-8.1) years. The cumulative recurrence rates of steatosis and steatohepatitis at 5 years were 80.0% and 60.3%, respectively. Significant risk factors for steatohepatitis recurrence in multivariate analysis were recipient age at LT <65 years (odds ratio [OR] 4.214; p = 0.044), high-density lipoprotein-cholesterol <1.15 mmol/L after LT (OR 3.463; p = 0.013) and grade ≥2 steatosis on the graft at 1 year after LT (OR 10.196; p = 0.001). The cumulative incidence of advanced fibrosis (F3-F4) was 20.0% at 5 years after LT and significant risk factors from multivariate analysis were metabolic syndrome before LT (OR 8.550; p = 0.038), long-term use of cyclosporine (OR 11.388; p = 0.031) and grade ≥2 steatosis at 1 year after LT (OR 10.720; p = 0.049). No re-LT was performed for NAFLD cirrhosis recurrence.Conclusion: Our results strongly suggest that recurrence of initial disease after LT for NAFLD is inevitable and progressive in a large proportion of patients; the means to prevent it remain to be further evaluated.Impact and implications: Non-alcoholic fatty liver disease (NAFLD) is a growing indication for liver transplantation, but the analysis of disease recurrence, based on graft liver biopsies, has been poorly studied. Cumulative incidences of steatosis, steatohepatitis and NAFLD-related significant fibrosis recurrence at 5 years were 85.0%, 60.3% and 48.0%, respectively. Grade ≥2 steatosis on graft biopsy at 1 year (present in 25% of patients) is highly predictive of recurrence of steatohepatitis and advanced fibrosis: bariatric surgery should be discussed in these patients specifically.
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hal-04020048 , version 1 (30-05-2023)

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Paternité - Pas d'utilisation commerciale - Pas de modification

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François Villeret, Sébastien Dharancy, Domitille Erard, Armand Abergel, Louise Barbier, et al.. Inevitability of disease recurrence after liver transplantation for NAFLD cirrhosis. JHEP Reports Innovation in Hepatology, 2023, 5 (3), pp.100668. ⟨10.1016/j.jhepr.2022.100668⟩. ⟨hal-04020048⟩
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