title: The influence of nonalcoholic fatty liver disease and its associated comorbidities on liver transplant outcomes.
abstract: OBJECTIVE
  To define the influence of nonalcoholic fatty liver disease (NAFLD) and its associated comorbidities on liver transplant outcomes.
  
  
  BACKGROUND
  NAFLD cirrhosis is an increasing indication for transplant. The transplant outcomes of NAFLD patients with metabolic syndrome comorbidities remain unclear.
  
  
  METHODS
  We examined a single center, retrospective cohort between 2004 and 2007 to determine transplant mortality for NAFLD and non-NAFLD patients accounting for the possible independent effects of diabetes, hypertension, obesity, and hyperlipidemia. The primary outcomes were 30-day, 1-year, and 3-year all-cause mortality. Cox proportional hazard ratios were determined controlling for various recipient and donor covariates.
  
  
  RESULTS
  In our study, of 118 liver transplants, 18% were performed for NAFLD cirrhosis. Adjusted hazard ratios for death for NAFLD compared with non-NAFLD patients at 30 days, 1 year, and 3 years were 8.96 (1.06, 75.8), 1.49 (0.38, 5.81), and 1.05 (0.29, 3.78), respectively. Compared with nondiabetic patients, diabetic patients had hazard ratios at 30 days, 1 year, and 3 years of 2.02 (0.31, 12.9), 2.82 (0.94, 8.47), 3.58 (1.32, 9.71), respectively. Obesity, hypertension, and hyperlipidemia did not have a significant impact on posttransplant mortality.
  
  
  CONCLUSIONS
  We conclude that NAFLD increases 30-day transplant mortality whereas diabetes increases 3-year mortality. Future work should determine the strategies to decrease perioperative mortality among NAFLD patients and ways to improve long-term transplant survival among diabetics.
authors: Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7080, USA. abarritt@unch.unc.edu
authors: A Sidney
authors: AS
authors: Barritt
authors: Evan S
authors: ES
authors: Dellon
authors: Tomasz
authors: T
authors: Kozlowski
authors: David A
authors: DA
authors: Gerber
authors: Paul H
authors: PH
authors: Hayashi
mesh_terms: D015897:Comorbidity; D003920:Diabetes Mellitus / Q000473:pathology; D005234:Fatty Liver / Q000150:complications / Q000628:therapy; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications* / Q000473:pathology; D006973:Hypertension / Q000150:complications* / Q000473:pathology; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology / Q000628:therapy; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000150:complications* / Q000473:pathology; D016016:Proportional Hazards Models; D016896:Treatment Outcome