title: Nonalcoholic fatty liver disease increases the risk of hepatocellular carcinoma in patients with alcohol-associated cirrhosis awaiting liver transplants.
abstract: OBJECTIVE
  Many patients with alcohol-associated cirrhosis also have diabetes, obesity, or insulin resistance-mediated steatosis, but little is known about how these disorders affect the severity of liver disease. We analyzed the prevalence and prognostic implications of metabolic risk factors (MRFs) such as overweight, diabetes, dyslipidemia, and hypertension in patients with alcohol-associated cirrhosis awaiting liver transplants.
  
  
  METHODS
  We performed a retrospective study of 110 patients with alcohol-associated cirrhosis (77% male; mean age, 55 y; 71% with >6 mo of abstinence) who received liver transplants at a single center in Paris, France, from 2000 through 2013. We collected data on previous exposure to MRFs, steatosis (>10% in the explant), and histologically confirmed hepatocellular carcinoma (HCC).
  
  
  RESULTS
  HCC was detected in explants from 29 patients (26%). Steatosis was detected in explants from 47 patients (70% were abstinent for ≥6 mo); 50% had a history of overweight or type 2 diabetes. Fifty-two patients (47%) had a history of MRFs and therefore were at risk for nonalcoholic fatty liver disease. A higher proportion of patients with MRF had HCC than those without MRF (46% vs 9%; P < .001). A previous history of overweight or type 2 diabetes significantly increased the risk for HCC (odds ratio, 6.23; 95% confidence interval [CI], 2.47-15.76, and odds ratio, 4.63; 95% CI, 1.87-11.47, respectively; P < .001). MRF, but not steatosis, was associated with the development of HCC (odds ratio, 11.76; 95% CI, 2.60-53; P = .001) independent of age, sex, amount of alcohol intake, or severity of liver disease.
  
  
  CONCLUSIONS
  Patients with alcohol-associated cirrhosis who received transplants frequently also had nonalcoholic fatty liver disease. MRFs, particularly overweight, obesity, and type 2 diabetes, significantly increase the risk of HCC.
authors.affiliation: Service d'Hépatogastroentérologie, Hôpital Pitié Salpêtrière, Paris, France.
authors.forename: Raluca
authors.initials: R
authors.lastname: Pais
authors.affiliation: Service d'Hépatogastroentérologie, Hôpital Pitié Salpêtrière, Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Lebray
authors.affiliation: Service de Chirurgie Hépatobiliaire et de Transplantation, Hôpital Pitié Salpêtrière, Paris, France.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Rousseau
authors.affiliation: Service d'Anatomie Pathologique, Hôpital Pitié Salpêtrière, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Charlotte
authors.affiliation: Service d'Hépatogastroentérologie, Hôpital Pitié Salpêtrière, Paris, France.
authors.forename: Ghizlaine
authors.initials: G
authors.lastname: Esselma
authors.affiliation: Service de Chirurgie Hépatobiliaire et de Transplantation, Hôpital Pitié Salpêtrière, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Savier
authors.affiliation: Service d'Hépatogastroentérologie, Hôpital Pitié Salpêtrière, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Thabut
authors.affiliation: Service d'Hépatogastroentérologie, Hôpital Pitié Salpêtrière, Paris, France.
authors.forename: Marika
authors.initials: M
authors.lastname: Rudler
authors.affiliation: Service d'Anesthésie et Réanimation, Hôpital Pitié Salpêtrière, Paris, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Eyraud
authors.affiliation: Service d'Anesthésie et Réanimation, Hôpital Pitié Salpêtrière, Paris, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Vezinet
authors.affiliation: Service de Chirurgie Hépatobiliaire et de Transplantation, Hôpital Pitié Salpêtrière, Paris, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Siksik
authors.affiliation: Service de Chirurgie Hépatobiliaire et de Transplantation, Hôpital Pitié Salpêtrière, Paris, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Vaillant
authors.affiliation: Service de Chirurgie Hépatobiliaire et de Transplantation, Hôpital Pitié Salpêtrière, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Hannoun
authors.affiliation: Service d'Hépatogastroentérologie, Hôpital Pitié Salpêtrière, Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Poynard
authors.affiliation: Service d'Hépatogastroentérologie, Hôpital Pitié Salpêtrière, Paris, France. Electronic address: vlad.ratziu@upmc.fr.
authors.forename: Vlad
authors.initials: V
authors.lastname: Ratziu
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology; D005234:Fatty Liver / Q000150:complications / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D008113:Liver Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications*; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D010297:Paris; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: Alcohol; Fatty Liver; Hepatocellular Carcinoma; Liver Transplantation; Metabolic Risk Factors