Diabetes to Liver Disease to Transplant

Obesity and diabetes lead to rise in nonalcoholic steatohepatitis but transplant survival rates are excellent

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) As the rates of obesity and diabetes continue to rise in the United States, so do the rates of complications related to these conditions. Nonalcoholic steatohepatitis (NASH) is one of these complications.

The proportion of people receiving liver transplants as a result of NASH has increased substantially in the last 15 years. Nonetheless, the survival rate of patients after surgery is excellent.

"Become an organ donor and save lives!"

Some studies have projected that the rates of NASH will rise dramatically by 2025. With the expected increase in NASH rates, the number of liver transplants needed is also expected to rise. As new cases of NASH develop, it is possible that the shortage of available organs becomes even worse.

""The need for organ donation continues to rise with more than 112,000 men, women, and children awaiting a life-saving transplant," says Michelle Segovia, of the Texas Organ Sharing Alliance.

"16,000 of those are in need of liver transplants. Unfortunately, the number of organ donors remains the same with only about 8,000 people donating each year. The result is that 19 people die each day due to the drastic shortage.

You can make the choice to save lives, please register to be an organ donor at www.donatelife.net."

Anita Afzali, M.D., M.P.H., of the University of Washington in Seattle, and colleagues wanted to study how many liver transplants were performed on NASH patients.

They also estimated the survival rates of patients after liver transplant surgery.

According to Dr. Afzali, as the rise in obesity and diabetes is leading to a rise in cases of NASH and other liver diseases, it is important to understand how obesity and diabetes have an impact on patients after liver transplantation.

NASH is caused by the buildup of fat in the liver. This fat is harmful to the liver and can lead to cirrhosis - the final phase of chronic liver disease in which the liver is scarred and functions poorly. NASH can also lead to liver cancer and liver failure.

From their study, the researchers found that the proportion of transplantations for cirrhosis caused by NASH increased from 1.2 percent between 1997 and 2003 to 7.4 percent between 2004 and 2010. That is, there were only 279 liver transplantations for NASH-cirrhosis from 1997 to 2003, while 1,531 were performed between 2004 and 2010.

While the rise in NASH is alarming, the survival rates of transplant patients paint a better picture. The study's results showed that 88 percent of transplant patients with NASH survived after one year.

The survival rate after three years was 82 percent. After five years, the survival rate remained fairly high at 77 percent.

Dr. Afzali concludes that her team's study demonstrates that the survival rate of liver transplant patients with NASH is excellent and similar to that of patients with other liver diseases.

"With the shortage of available donor organs," Dr. Afzali explains, "appropriate allocation of livers is an important concern for transplant centers and our findings indicate NASH-cirrhosis patients are potentially good candidates for liver transplantation."

She cautions that all patients should be screened for heart disease before transplantation, and that they should all be monitored for underlying heart and metabolic conditions after transplantation. Doing so will increase a patient's chance of survival.

For their study, the researchers looked at data from the United Network for Organ Sharing. They used data from a total of 53,738 liver transplant patients 18 years of age and older who underwent transplantation between January 1, 1997 and October 31, 2010.

When comparing NASH to other diseases - such as hepatocellular carcinoma (HCC), hepatitis C, and alcohol-related liver disease - the researchers found that NASH was the fourth most common reason for liver transplantation.

NASH patients had better survival rates than those with HCC, hepatitis C, alcoholic liver disease, acute hepatic necrosis, hemochromatosis, and cryptogenic liver disease.

However, NASH patients had lower survival rates than patients with primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), autoimmune hepatitis, and HBV.

The results of this study are published in the journal Liver Transplantation

Reviewed by: 
Review Date: 
December 14, 2011
Last Updated:
December 15, 2011