1-year outcomes for lung transplantation recipients with non-alcoholic fatty liver disease.

Autor: Trindade AJ; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.; Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA., Thaniyavarn T; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA., Hashemi N; Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA., Coppolino A 3rd; Division of Thoracic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA., Kennedy JC; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA., Mallidi HR; Division of Thoracic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.; Division of Cardiac Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA., El-Chemaly S; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA., Goldberg HJ; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
Jazyk: angličtina
Zdroj: ERJ open research [ERJ Open Res] 2021 Aug 23; Vol. 7 (3). Date of Electronic Publication: 2021 Aug 23 (Print Publication: 2021).
DOI: 10.1183/23120541.00103-2021
Abstrakt: Advanced hepatic fibrosis and cirrhosis are absolute contraindications to lung transplantation. [ 1] However, whether fatty liver disease with mild-moderate fibrosis contributes to increased adverse outcomes post-lung transplantation remains unknown.  We present a retrospective analysis of patients transplanted at Brigham and Women's Hospital between 2015 and 2017 to identify whether patients with mild-moderate non-alcoholic fatty liver disease (NAFLD) experience increased short-term complications compared to patients with normal liver architecture. Patients with advanced (F3-F4) fibrosis and/or cirrhosis were considered non-suitable transplant candidates, a priori . This study was powered for a difference in index hospital-free days within the first 30 days of 25% (α=0.05, β=0.8). Secondary outcomes included index intensive care unit (ICU)-free days within the first 10 days post-transplant, perioperative blood product transfusion, incidence of index hospitalisation arrhythmias and delirium, need for insulin on discharge post-transplant, tacrolimus dose required to maintain a trough of 8-12 ng·mL -1 at index hospital discharge, and 1-year post-transplant incidence of insulin-dependent diabetes, acute kidney injury, acute cellular rejection, unplanned hospital readmissions and infection.  150 patients underwent lung transplantation between 2015 and 2017 and were included in the analysis; of these patients 40 (27%) had evidence of NAFLD. Median index hospital-free days for patients with NAFLD were non-inferior to those without (16 days, IQR 10.5-19.5 versus 12 days, IQR 0-18.0, p=0.03). Regarding secondary outcomes, both index hospitalisation and 1-year outcomes were non-inferior between patients with NAFLD and those with normal liver architecture.  This study demonstrates that mild-moderate severity NAFLD may not be a contraindication to lung transplantation.
Competing Interests: Conflict of interest: Dr. Trindade has nothing to disclose. Conflict of interest: Dr. Thaniyavarn has nothing to disclose. Conflict of interest: Dr. Hashemi has nothing to disclose. Conflict of interest: Dr. Coppolino has nothing to disclose. Conflict of interest: Dr. Kennedy has nothing to disclose. Conflict of interest: Dr. Mallidi has nothing to disclose. Conflict of interest: Dr. El-Chemaly has nothing to disclose. Conflict of interest: Dr. Goldberg has nothing to disclose.
(Copyright ©The authors 2021.)
Databáze: MEDLINE
Externí odkaz: