Recurrence of non-alcoholic steatohepatitis and cryptogenic cirrhosis following orthotopic liver transplantation in the context of the metabolic syndrome.
BACKGROUND
Non-alcoholic steatohepatitis (NASH) and cryptogenic cirrhosis (CC) are increasing indications for orthotopic liver transplantation (OLT). The aim of this study is to describe our outcomes and delineate predictors of recurrence of NASH and CC after OLT.


METHODS
This is a retrospective study from 1996 to 2008. Donor and recipient demographics, metabolic profile, insulin and steroid intake, immunosuppression regimen, operative factors, outcomes, and pathologies were reviewed. Fisher's exact test, Cox regression models, and Kaplan-Meier plots were used.


RESULTS
A total of 83 patients were included. Recurrence occurred in 20 patients. Thirty-four percent of the patients with metabolic syndrome (MS) had recurrence of NASH or CC compared with 13% of the patients without MS (p = 0.05). Recurrence also occurred in 32% of the patients with hypertension (HTN) vs. 12% in those without HTN (p = 0.05). Thirty-seven percent of those on insulin had recurrence vs. 6% of those not on insulin (p = 0.05). Five-yr survival probability for patients with MS, HTN, and insulin use was 52%, 61%, and 58%, respectively.


CONCLUSIONS
Higher recurrence of NASH and CC was associated with presence of MS, HTN and insulin use. Recurrence should be further evaluated in larger studies, with special emphasis on management of MS and prevention strategies.
Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA.
Mazen M
MM
El Atrache
Marwan S
MS
Abouljoud
George
G
Divine
Atsushi
A
Yoshida
Dean Y
DY
Kim
Marwan M
MM
Kazimi
Dilip
D
Moonka
Mary A
MA
Huang
Kim
K
Brown
D000328:Adult; D000368:Aged; D005234:Fatty Liver / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate