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Progression of liver disease in NAFLD
LIVER TRANSPLANTATION FOR NASH
Didier Samuel
AP-HP Hôpital Paul Brousse
Centre Hépato-Biliaire
Villejuif, France
Email: didier.samuel@pbr.aphp.fr
Take home messages
• NASH is becoming the second indication for LT in The United States.
• In contrast, NASH represents <5% of the indications in Europe.
• NASH-related HCC is a growing indication for LT.
• NASH is frequently associated with comorbidities, in particular obesity and diabetes.
• Morbid obesity is associated with increased perioperative morbidity.
• NAFLD recurrence is observed in 50% of patients at two years.
• Long-term outcome is similar to other indications.
Introduction
Worldwide, the main indications for LT are HCV cirrhosis, alcoholic cirrhosis and HCC. In East Asia,
HBV-related or HCC-related cirrhosis are the main indications for LT. LTs for decompensated HBV
cirrhosis have decreased over the last five years thanks to improvements in antiviral therapies. Moreover,
direct-acting antiviral agents will impact the number of patients requiring LT for HCV decompensated
liver cirrhosis. The main indications for LT in Europe are HCV cirrhosis, alcoholic cirrhosis and HCC.
We may expect to see a shift in the indications for LT within the next five years among the causes of
cirrhosis and the causes of HCC.
NASH
The disappearance of some of the histological features of NASH in the end stages of the disease can
make diagnosis difficult, particularly in the absence of a well-documented medical history.
Furthermore, the diagnosis of alcoholic cirrhosis may be overestimated in Europe. Indeed in many
cases, coexistence of lesions of NASH and of alcoholic steatohepatitis (ASH) are potential causes of
cirrhosis in patients who have a regular moderate drinking and predisposing factors for NASH. The
impact of NASH in Europe may therefore be underestimated. Several groups have combined patients
with NASH-related cirrhosis and patients with cryptogenic cirrhosis who have predisposing factors of
NASH to better evaluate the true incidence of the disease. The same applies to HCC, where the cause
of cirrhosis is sometimes unclear. In Europe, NASH remains a confidential cause for LT, representing
<5% of the indications. Between 2004 and 2013 in The United States, new LT waitlist registrants with
NASH increased by 170% (from 804 to 2174) and in 2013, NASH became the second-leading disease
among LT waitlist registrants, after HCV [1].
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 107
LIVER TRANSPLANTATION FOR NASH
Didier Samuel
AP-HP Hôpital Paul Brousse
Centre Hépato-Biliaire
Villejuif, France
Email: didier.samuel@pbr.aphp.fr
Take home messages
• NASH is becoming the second indication for LT in The United States.
• In contrast, NASH represents <5% of the indications in Europe.
• NASH-related HCC is a growing indication for LT.
• NASH is frequently associated with comorbidities, in particular obesity and diabetes.
• Morbid obesity is associated with increased perioperative morbidity.
• NAFLD recurrence is observed in 50% of patients at two years.
• Long-term outcome is similar to other indications.
Introduction
Worldwide, the main indications for LT are HCV cirrhosis, alcoholic cirrhosis and HCC. In East Asia,
HBV-related or HCC-related cirrhosis are the main indications for LT. LTs for decompensated HBV
cirrhosis have decreased over the last five years thanks to improvements in antiviral therapies. Moreover,
direct-acting antiviral agents will impact the number of patients requiring LT for HCV decompensated
liver cirrhosis. The main indications for LT in Europe are HCV cirrhosis, alcoholic cirrhosis and HCC.
We may expect to see a shift in the indications for LT within the next five years among the causes of
cirrhosis and the causes of HCC.
NASH
The disappearance of some of the histological features of NASH in the end stages of the disease can
make diagnosis difficult, particularly in the absence of a well-documented medical history.
Furthermore, the diagnosis of alcoholic cirrhosis may be overestimated in Europe. Indeed in many
cases, coexistence of lesions of NASH and of alcoholic steatohepatitis (ASH) are potential causes of
cirrhosis in patients who have a regular moderate drinking and predisposing factors for NASH. The
impact of NASH in Europe may therefore be underestimated. Several groups have combined patients
with NASH-related cirrhosis and patients with cryptogenic cirrhosis who have predisposing factors of
NASH to better evaluate the true incidence of the disease. The same applies to HCC, where the cause
of cirrhosis is sometimes unclear. In Europe, NASH remains a confidential cause for LT, representing
<5% of the indications. Between 2004 and 2013 in The United States, new LT waitlist registrants with
NASH increased by 170% (from 804 to 2174) and in 2013, NASH became the second-leading disease
among LT waitlist registrants, after HCV [1].
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 107
