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Villeret F, Dharancy S, Erard D, Abergel A, Barbier L, Besch C, Boillot O, Boudjema K, Coilly A, Conti F, Corpechot C, Duvoux C, Faitot F, Faure S, Francoz C, Giostra E, Gugenheim J, Hardwigsen J, Hilleret MN, Hiriart JB, Houssel-Debry P, Kamar N, Lassailly G, Latournerie M, Pageaux GP, Samuel D, Vanlemmens C, Saliba F, Dumortier J. Inevitability of disease recurrence after liver transplantation for NAFLD cirrhosis. JHEP Rep 2023; 5:100668. [PMID: 36852108 PMCID: PMC9957774 DOI: 10.1016/j.jhepr.2022.100668] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/16/2022] [Accepted: 12/07/2022] [Indexed: 01/04/2023] Open
Abstract
Background & Aims Liver transplantation (LT) is the only available treatment for end-stage non-alcoholic fatty liver disease (NAFLD) (related decompensated cirrhosis and/or hepatocellular carcinoma). The aim of our study was to evaluate the risk of disease recurrence after LT and the factors influencing it. Method This retrospective multicenter study included adults transplanted for NAFLD cirrhosis between 2000 and 2019 in 20 participating French-speaking centers. Disease recurrence (steatosis, steatohepatitis and fibrosis) was diagnosed from liver graft biopsies. Results We analyzed 150 patients with at least one graft liver biopsy available ≥6 months after transplantation, among 361 patients transplanted for NAFLD. The median (IQR) age at LT was 61.3 (54.4-64.6) years. The median follow-up after LT was 4.7 (2.8-8.1) years. The cumulative recurrence rates of steatosis and steatohepatitis at 5 years were 80.0% and 60.3%, respectively. Significant risk factors for steatohepatitis recurrence in multivariate analysis were recipient age at LT <65 years (odds ratio [OR] 4.214; p = 0.044), high-density lipoprotein-cholesterol <1.15 mmol/L after LT (OR 3.463; p = 0.013) and grade ≥2 steatosis on the graft at 1 year after LT (OR 10.196; p = 0.001). The cumulative incidence of advanced fibrosis (F3-F4) was 20.0% at 5 years after LT and significant risk factors from multivariate analysis were metabolic syndrome before LT (OR 8.550; p = 0.038), long-term use of cyclosporine (OR 11.388; p = 0.031) and grade ≥2 steatosis at 1 year after LT (OR 10.720; p = 0.049). No re-LT was performed for NAFLD cirrhosis recurrence. Conclusion Our results strongly suggest that recurrence of initial disease after LT for NAFLD is inevitable and progressive in a large proportion of patients; the means to prevent it remain to be further evaluated. Impact and implications Non-alcoholic fatty liver disease (NAFLD) is a growing indication for liver transplantation, but the analysis of disease recurrence, based on graft liver biopsies, has been poorly studied. Cumulative incidences of steatosis, steatohepatitis and NAFLD-related significant fibrosis recurrence at 5 years were 85.0%, 60.3% and 48.0%, respectively. Grade ≥2 steatosis on graft biopsy at 1 year (present in 25% of patients) is highly predictive of recurrence of steatohepatitis and advanced fibrosis: bariatric surgery should be discussed in these patients specifically.
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Key Words
- ABM, Agence de la Biomédecine
- BS, bariatric surgery
- Bariatric surgery
- CNI, calcineurin inhibitor
- CST, corticosteroid
- CV, cardiovascular
- CYA, cyclosporine
- ESLD, end-stage liver disease
- HCC, hepatocellular carcinoma
- LT, liver transplantation
- MS, metabolic syndrome
- NAFLD recurrence
- NAFLD, non-alcoholic fatty liver disease
- NASH
- NASH, non-alcoholic steatohepatitis
- liver transplantation
- mTOR-i, mTOR inhibitor
- metabolic syndrome
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Affiliation(s)
- François Villeret
- Service d’Hépatologie et de Transplantation Hépatique, Institut d’Hépatologie de Lyon, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France,Université Claude Bernard Lyon 1, Lyon, France
| | - Sébastien Dharancy
- Service des Maladies de l’Appareil Digestif, Hôpital Claude Huriez, CHRU Lille, Lille, France
| | - Domitille Erard
- Service d’Hépatologie et de Transplantation Hépatique, Institut d’Hépatologie de Lyon, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Armand Abergel
- Département de Médecine digestive, CHU Estaing, Clermont-Ferrand, France
| | - Louise Barbier
- Service de Chirurgie digestive, Oncologique et Transplantation Hépatique, Hôpital Trousseau, CHU Tours, Tours, France
| | - Camille Besch
- Service de Chirurgie Hépato-bilio-pancréatique et Transplantation Hépatique, CHRU Hautepierre, Strasbourg, France
| | - Olivier Boillot
- Fédération des Spécialités Digestives, Institut d’Hépatologie de Lyon, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Karim Boudjema
- Service de Chirurgie Hépatobiliaire et digestive, Hôpital Universitaire de Pontchaillou, Rennes, France
| | - Audrey Coilly
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Université Paris Saclay, Unité Inserm 1193, AP-HP, Villejuif, France
| | - Filomena Conti
- Sorbonne Université, CRSA, APHP, Unité Médicale de Transplantation Hépatique, Service d’Hépatogastroentérologie, Hôpital Pitié Salpêtrière, Paris, France
| | - Christophe Corpechot
- Service d'Hépatologie, Hôpital Saint-Antoine, CHU Saint-Antoine, APHP, Paris, France
| | | | - François Faitot
- Service de Chirurgie Hépato-bilio-pancréatique et Transplantation Hépatique, CHRU Hautepierre, Strasbourg, France
| | - Stéphanie Faure
- Service d’Hépato-gastroentérologie et Transplantation Hépatique, CHU Saint-Eloi, Université de Montpellier, Montpellier, France
| | - Claire Francoz
- Service d'Hépatologie et Transplantation Hépatique, Hôpital Beaujon, APHP, Clichy, France
| | - Emiliano Giostra
- Service de Gastroentérologie et Hépatologie, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Jean Gugenheim
- Service de Chirurgie Digestive et Centre de Transplantation Hépatique, Université Côte d’Azur, CHU l’Archet, Nice, France
| | - Jean Hardwigsen
- Service Chirurgie Générale et Transplantation Hépatique, Hôpital La Timone, APHM, Marseille, France
| | | | - Jean-Baptiste Hiriart
- Service d'Hépatologie et de Transplantation Hépatique, CHU Haut-Lévêque, Pessac, France
| | - Pauline Houssel-Debry
- Service des Maladies du Foie, Hôpital Universitaire de Pontchaillou, CHU de Rennes, Rennes, France
| | - Nassim Kamar
- Département de Néphrologie et Transplantation d'Organes, CHU Rangueil, Toulouse, France
| | - Guillaume Lassailly
- Service des Maladies de l’Appareil Digestif, Hôpital Claude Huriez, CHRU Lille, Lille, France
| | - Marianne Latournerie
- Service d’hépatologie et de Gastro-entérologie, CHU Dijon-Bourgogne, Dijon, France
| | - Georges-Philippe Pageaux
- Service d’Hépato-gastroentérologie et Transplantation Hépatique, CHU Saint-Eloi, Université de Montpellier, Montpellier, France
| | - Didier Samuel
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Université Paris Saclay, Unité Inserm 1193, AP-HP, Villejuif, France
| | - Claire Vanlemmens
- Service d'Hépatologie et Soins Intensifs Digestifs, CHU Jean Minjoz, Besançon, France
| | - Faouzi Saliba
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Université Paris Saclay, Unité Inserm 1193, AP-HP, Villejuif, France
| | - Jérôme Dumortier
- Université Claude Bernard Lyon 1, Lyon, France,Fédération des Spécialités Digestives, Institut d’Hépatologie de Lyon, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France,Corresponding author. Address: Pavillons L, Hôpital Edouard Herriot, 69437 Cedex 03, Lyon, France; Tel.: (33) 4 72 11 01 11; fax: (33) 4 72 11 01 47
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Ekpanyapong S, Philips N, Loza BL, Abt P, Furth EE, Tondon R, Khungar V, Olthoff K, Shaked A, Hoteit MA, Reddy KR. Predictors, Presentation, and Treatment Outcomes of Recurrent Hepatocellular Carcinoma After Liver Transplantation: A Large Single Center Experience. J Clin Exp Hepatol 2020; 10:304-315. [PMID: 32655233 PMCID: PMC7335705 DOI: 10.1016/j.jceh.2019.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Liver transplantation (LT) is an accepted therapeutic option for hepatocellular carcinoma (HCC) in patients with cirrhosis. Despite careful candidate selection, HCC recurrence occurs. We aimed to describe the predictors of recurrence, clinical presentation, and predictors of survival after HCC recurrence post-LT. METHODS Patients with recurrent HCC after LT between January 1996 and December 2017 were retrospectively reviewed. RESULTS Of 711 patients, 96 (13.5%) patients had post-LT HCC recurrence. The median time to recurrence was 17.1 months, and the median survival was 10.1 months. Initial recurrence was more often in the graft (34.4%), and most (60.4%) had multiple recurrent lesions, and 26% were in multiple sites. In multivariate analysis, factors associated with shorter survival were poorly differentiated histology in explant (Hazard ratio [HR] = 1.96; p = 0.027), bilirubin ≥1.2 mg/dL (HR = 2.47; p = 0.025), and albumin <3.5 mg/dL (HR = 2.13; p = 0.014) at recurrence, alpha-fetoprotein at recurrence ≥ 1000 ng/mL (HR = 2.96; p = 0.005), and peritoneal disease (HR = 3.20; p = 0.022). There was an increased survival in patients exposed to sirolimus (HR = 0.32; p < 0.0001). CONCLUSIONS Recurrent HCC after LT is often in extrahepatic sites with a decreased survival in those with poorly differentiated explant pathology, high bilirubin, low albumin, marked elevation of alpha-fetoprotein at recurrence, and peritoneal recurrence. Sirolimus-based immunosuppression may provide benefit.
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Key Words
- AFP, alpha-fetoprotein
- ALP, alkaline phosphatase
- ALT, alanine transaminase
- CNI, calcineurin inhibitor
- CT, computed tomography
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- INR, international normalized ratio
- LT, Liver transplantation
- MRI, magnetic resonance imaging
- NASH, nonalcoholic steatohepatitis
- RETREAT, Risk Estimation of Tumor Recurrence After Transplant
- RFA, radiofrequency ablation
- TACE, transarterial chemoembolization
- UCSF, University of California San Francisco
- UNOS, United Network for Organ Sharing
- hepatocellular carcinoma
- immunosuppression
- liver transplantation
- mTOR, mammalian target of rapamycin
- recurrence
- survival
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Affiliation(s)
- Sirina Ekpanyapong
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Neil Philips
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Bao-Li Loza
- Department of Surgery, Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter Abt
- Department of Surgery, Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Emma E. Furth
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rashmi Tondon
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vandana Khungar
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Kim Olthoff
- Department of Surgery, Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Abraham Shaked
- Department of Surgery, Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Maarouf A. Hoteit
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
| | - K. Rajender Reddy
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
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Goklemez S, Curtis LM, Hawwa A, Ling A, Avila D, Heller T, Pavletic SZ. Achalasia in a Patient Undergoing Hematologic Stem Cell Transplant After Exposure to Tacrolimus. Mayo Clin Proc Innov Qual Outcomes 2018; 1:198-201. [PMID: 30225417 PMCID: PMC6134909 DOI: 10.1016/j.mayocpiqo.2017.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Calcineurin inhibitors (CNIs) are effective agents used for prevention of graft-vs-host disease after allogeneic hematopoietic stem cell transplant or for organ rejection in solid-organ transplant. However, CNIs have a wide range of adverse effects that may necessitate changing to another CNI or immunosuppressive agent. We report a case of acute myeloid leukemia in which achalasia developed after exposure to tacrolimus, as revealed by esophagram results. The patient's symptoms and signs were ameliorated after a change to cyclosporine. This case is the first in the literature to reveal achalasia associated with tacrolimus. Achalasia should be part of a differential diagnosis of upper gastrointestinal symptoms in patients undergoing transplant, and changing to another CNI may be a useful therapeutic intervention.
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Affiliation(s)
- Sencer Goklemez
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Lauren M Curtis
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Alao Hawwa
- Translational Hepatology Unit, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Alexander Ling
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD
| | - Daniele Avila
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Theo Heller
- Translational Hepatology Unit, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Steven Z Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
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