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Medina-Morales E, Ismail M, Goyal RM, Marenco-Flores A, Saberi B, Fricker Z, Bonder A, Trivedi HD. Waitlist and transplant outcomes in patients with metabolic dysfunction-associated steatotic liver disease and autoimmune hepatitis. Liver Int 2024. [PMID: 39258855 DOI: 10.1111/liv.16100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 08/06/2024] [Accepted: 08/31/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND AND AIMS Metabolic dysfunction-associated steatotic liver disease (MASLD), in the context of autoimmune hepatitis (AIH) among liver transplantation (LT) candidates or recipients remains poorly understood. This study compares waitlist and post-LT outcomes in patients with MASLD/AIH to MASLD and AIH alone. METHODS Using the united network organ sharing database (2002-2022), we compared waitlist outcomes and post-LT survival among patients with MASLD/AIH (n = 282), AIH (n = 5812), and MASLD (n = 33 331). Competing risk, Kaplan Meier estimates and Cox proportional hazard analyses were performed. RESULTS MASLD/AIH group had the highest rates of encephalopathy and ascites, and highest MELD scores. MASLD/AIH patients had higher transplantation incidence (adjusted subdistribution hazard ratio [aSHR] 1.64, 95% CI 1.44-1.85; p < .001) and lower waitlist removal risk (aSHR .30, 95% CI .20-.44; p < .001) compared to MASLD alone. One-year post-LT survival favoured MASLD compared to AIH (patient: 92% vs. 91%, p < .001; graft: 89% vs. 88%, p < .001) and MASLD/AIH (patient: 92% vs. 90%, p = .008; graft: 89% vs. 88%, p = .023). Recipients with MASLD/AIH showed no significant difference in survival at 10-year post-LT compared to MASLD (patient: 63% vs. 61%, p = .68; graft 60% vs. 59%, p = .83) and AIH (patient: 63% vs. 70%, p = .07; graft: 60% vs. 64%, p = .42). CONCLUSIONS Our study showed that MASLD/AIH patients demonstrate higher LT incidence and lower dropout rates. Long-term post-LT outcomes did not significantly differ between groups. Further prospective multicenter studies are needed to validate these findings.
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Affiliation(s)
- Esli Medina-Morales
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Mohamed Ismail
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Ritik M Goyal
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Ana Marenco-Flores
- Division of Gastroenterology, Hepatology and Nutrition, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Behnam Saberi
- Division of Gastroenterology, Hepatology and Nutrition, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Zachary Fricker
- Division of Gastroenterology, Hepatology and Nutrition, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Alan Bonder
- Division of Gastroenterology, Hepatology and Nutrition, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Hirsh D Trivedi
- Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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2
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Erard D, Villeret F, Chouik Y, Guillaud O, Scoazec JY, Caussy C, Disse E, Boillot O, Hervieu V, Dumortier J. Dual alcohol and metabolic-related liver disease: Results from a population of liver transplant patients. Liver Int 2024; 44:422-432. [PMID: 38010979 DOI: 10.1111/liv.15779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 10/22/2023] [Accepted: 10/25/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND & AIMS If alcohol-related liver disease (ALD) and nonalcoholic fatty liver disease (NAFLD) are now the two main indications for liver transplantation (LT), it has been recognized that both conditions can coexist in varying degrees and the concept of dual-aetiology fatty liver disease (DAFLD) has been proposed. This retrospective study aimed to evaluate, in a cohort of patients transplanted for ALD and NAFLD, the prevalence of DAFLD before LT and the impact on liver graft outcome. METHODS From 1990 to 2010, all patients who underwent LT for the so-called ALD or NAFLD in our centre were included. Before LT, DAFLD was defined as patients with a history of excessive alcohol consumption and obesity associated with either diabetes or hypertension. Before LT, patients were separated into three groups: DAFLD, ALD, and NAFLD. Fatty liver graft disease was classified according to the FLIP algorithm. RESULTS Out of 907, adult LT recipients were identified: 33 DAFLD patients, 333 ALD patients, and 24 NAFLD patients. After LT, ALD patients experienced significantly more alcohol relapse than DAFLD patients, who had twice more post-LT metabolic syndrome. Out of 926, post-LT biopsies, DAFLD patients had significantly more fatty liver graft disease due to metabolic syndrome features than ALD patients. CONCLUSION Our results support that DAFLD recently emerged as an indication of LT. In the future, this particular population needs to be identified as a specific entity since post-LT outcome on the graft is different from ALD and more similar to NAFLD patients.
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Affiliation(s)
- Domitille Erard
- Service d'hépatologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - François Villeret
- Service d'hépatologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
| | - Yasmina Chouik
- Service d'hépatologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
| | - Olivier Guillaud
- Fédération des spécialités digestives, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jean-Yves Scoazec
- Université Claude Bernard Lyon 1, Lyon, France
- Service d'anatomie pathologique, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Cyrielle Caussy
- Université Claude Bernard Lyon 1, Lyon, France
- Service d'endocrinologie, diabète et nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Univ Lyon, CarMen Laboratory, INSERM, INRA, INSA Lyon, Pierre-Bénite, France
| | - Emmanuel Disse
- Université Claude Bernard Lyon 1, Lyon, France
- Service d'endocrinologie, diabète et nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Olivier Boillot
- Université Claude Bernard Lyon 1, Lyon, France
- Fédération des spécialités digestives, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Valérie Hervieu
- Université Claude Bernard Lyon 1, Lyon, France
- Service d'anatomie pathologique, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Dumortier
- Université Claude Bernard Lyon 1, Lyon, France
- Fédération des spécialités digestives, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
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3
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Fang Y, Bian C, Li Z, Jin L, Chen C, Miao Y, Huang H, Zeng Z. ScRNA-seq revealed disruption in CD8 + NKG2A + natural killer T cells in patients after liver transplantation and immunosuppressive therapy. Immun Inflamm Dis 2023; 11:e990. [PMID: 37773707 PMCID: PMC10524014 DOI: 10.1002/iid3.990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/21/2023] [Accepted: 08/07/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Liver transplantation (LT) offers a good survival chance for both the patient in short or long term, but still faces many challenges in the treatment of LT, such as the side effects associated with long-term immunosuppression, which is one of the side effects that occurs in most patients. However, the dynamics of the cellular immune system composition over time during immune tolerance to LT after immunosuppressive therapy are not known. METHODS Using single-cell transcriptome sequencing, we analyzed five peripheral blood samples (one normal individual and four patients who underwent LT and received immunosuppressive therapy for 2 months, 1 year, 3 years, and 7 years, respectively) for immune cell composition and gene expression. RESULTS A total of 17,462 peripheral blood mononuclear cells were acquired from a normal individual without LT and patients who underwent LT and received immunosuppressive therapy for 2 months, 1 year, 3 years, and 7 years, respectively. A total of 24 cell clusters were obtained and categorized into four different cell types based on gene expression characteristics as follows: eight clusters of T cells, two clusters of B cells, two clusters of neutrophils, two clusters of monocytes, natural killer cells, and natural killer T (NKT) cells (n = 4), and six other cell clusters. Cell subset analysis, pseudotime analysis, and intercellular communication analysis revealed that the CD8+ NKT cells specifically expressed NKG2A (KLRC1, CD159A), which may be an important cell group for CD8+ NKG2A+ NKT cells in LT, thereby highlighting the heterogeneity and functional diversity in patients who undergo LT. CONCLUSIONS We comprehensively analyzed single-cell RNA sequencing data from a normal individual and patients who underwent LT and elucidated the mechanism underlying the development of immune tolerance in LT. CD8+ NKT cells specifically expressing KLRC1 play a crucial role in LT, and dynamic monitoring of these cells may provide novel avenues for the diagnosis and treatment of LT-related immune rejection.
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Affiliation(s)
- Yuan Fang
- Organ Transplantation Centerthe First Affiliated Hospital of Kunming Medical UniversityKunmingYunnanPR China
| | - CongWen Bian
- Organ Transplantation Centerthe First Affiliated Hospital of Kunming Medical UniversityKunmingYunnanPR China
| | - ZhiTao Li
- Organ Transplantation Centerthe First Affiliated Hospital of Kunming Medical UniversityKunmingYunnanPR China
| | - Li Jin
- Organ Transplantation Centerthe First Affiliated Hospital of Kunming Medical UniversityKunmingYunnanPR China
| | - ChuHong Chen
- Organ Transplantation Centerthe First Affiliated Hospital of Kunming Medical UniversityKunmingYunnanPR China
| | - YingLei Miao
- Yunnan Province Clinical Research Center for Digestive DiseasesYunnanPR China
| | - HanFei Huang
- Organ Transplantation Centerthe First Affiliated Hospital of Kunming Medical UniversityKunmingYunnanPR China
| | - Zhong Zeng
- Organ Transplantation Centerthe First Affiliated Hospital of Kunming Medical UniversityKunmingYunnanPR China
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4
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Fuochi E, Anastasio L, Lynch EN, Campani C, Dragoni G, Milani S, Galli A, Innocenti T. Main factors influencing long-term outcomes of liver transplantation in 2022. World J Hepatol 2023; 15:321-352. [PMID: 37034235 PMCID: PMC10075010 DOI: 10.4254/wjh.v15.i3.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/24/2022] [Accepted: 02/22/2023] [Indexed: 04/11/2023] Open
Abstract
Liver transplant (LT) outcomes have markedly improved in the recent decades, even if long-term morbidity and mortality are still considerable. Most of late deaths are independent from graft function and different comorbidities, including complications of metabolic syndrome and de novo neoplasms, seem to play a key role in determining long-term outcomes in LT recipients. This review discusses the main factors associated with late mortality and suggests possible strategies to improve long-term management and follow-up after liver transplantation. In particular, the reduction of drug toxicity, the use of tools to identify high-risk patients, and setting up a multidisciplinary team also for long-term management of LT recipients may further improve survival after liver transplantation.
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Affiliation(s)
- Elisa Fuochi
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Lorenzo Anastasio
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Erica Nicola Lynch
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Claudia Campani
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
- Department of Medical Biotechnologies, University of Siena, Siena 53100, Italy
| | - Stefano Milani
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Andrea Galli
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Tommaso Innocenti
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
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5
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Farrugia MA, Le Garf S, Chierici A, Piche T, Gual P, Iannelli A, Anty R. Therapeutic Physical Exercise Programs in the Context of NASH Cirrhosis and Liver Transplantation: A Systematic Review. Metabolites 2023; 13:330. [PMID: 36984770 PMCID: PMC10053873 DOI: 10.3390/metabo13030330] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/11/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
In recent years, various physical exercise interventions have been developed with a view to reducing comorbidity and morbidity rates among patients with chronic diseases. Regular physical exercise has been shown to reduce hypertension and mortality in patients with type 2 diabetes. Diabetes and obesity are often associated with the development of nonalcoholic fatty liver disease, which can lead to liver fibrosis and then (in some cases) nonalcoholic steatohepatitis cirrhosis. We searched the literature for publications on personalized physical exercise programs in cirrhotic patients before and after liver transplantation. Eleven studies in cirrhotic patients and one study in liver transplant recipients were included in the systematic review, the results of which were reported in compliance with the preferred reporting items for systematic reviews and meta-analyses guidelines. The personalized physical exercise programs lasted for 6 to 16 weeks. Our review evidenced improvements in peak oxygen consumption and six-minute walk test performance and a reduction in the hepatic venous pressure gradient. In cirrhotic patients, personalized physical exercise programs improve quality of life, are not associated with adverse effects, and (for transplant recipients) might reduce the 90-day hospital readmission rate. However, none of the literature data evidenced reductions in the mortality rates before and after transplantation. Further prospective studies are needed to evaluate the benefit of long-term physical exercise programs in cirrhotic patients before and after liver transplantation.
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Affiliation(s)
- Marwin A. Farrugia
- Digestive Center, Centre Hospitalier Universitaire, Archet 2 Hospital, Université Côte d’Azur, 06000 Nice, France
| | - Sebastien Le Garf
- CSO PACA-Est, INSERM, C3M, Université Côte d’Azur, CEDEX 3, 06000 Nice, France
| | - Andrea Chierici
- Centre Hospitalier Universitaire de Nice—Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Université Côte d’Azur, 06000 Nice, France
| | - Thierry Piche
- Centre Hospitalier Universitaire, INSERM, U1065, C3M, Université Côte d’Azur, 06000 Nice, France
| | - Philippe Gual
- INSERM, U1065, C3M, Université Côte d’Azur, 06000 Nice, France
| | - Antonio Iannelli
- Centre Hospitalier Universitaire de Nice—Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, INSERM U1065, Team 8 “Hepatic complications of obesity and alcohol”, Université Côte d’Azur, 06000 Nice, France
| | - Rodolphe Anty
- Digestive Center, Centre Hospitalier Universitaire, Archet 2 Hospital, Université Côte d’Azur, 06000 Nice, France
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6
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Jiang YZ, Zhou GP, Zhu ZJ, Sun LY. Predictors of mid-term survival after liver transplantation in patients with NAFLD cirrhosis. Liver Int 2022; 42:2912-2913. [PMID: 36114761 DOI: 10.1111/liv.15427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 02/13/2023]
Affiliation(s)
- Yi-Zhou Jiang
- Department of Critical Liver Diseases, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China
| | - Guang-Peng Zhou
- Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China
| | - Zhi-Jun Zhu
- Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China
| | - Li-Ying Sun
- Department of Critical Liver Diseases, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China
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7
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Villeret F, Dumortier J. Response to 'Predictors of mid-term survival after liver transplantation in patients with NAFLD cirrhosis'. Liver Int 2022; 42:2914-2915. [PMID: 36128907 DOI: 10.1111/liv.15429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 12/12/2022]
Affiliation(s)
- François Villeret
- Service d'hépatologie et de transplantation hépatique, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Jérôme Dumortier
- Université Claude Bernard Lyon 1, Lyon, France.,Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices civils de Lyon, Lyon, France
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