代谢功能障碍相关性脂肪肝和自身免疫性肝炎患者的候选名单和移植结果

IF 6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver International Pub Date : 2024-09-11 DOI:10.1111/liv.16100

Esli Medina‐Morales, Mohamed Ismail, Ritik M. Goyal, Ana Marenco‐Flores, Behnam Saberi, Zachary Fricker, Alan Bonder, Hirsh D. Trivedi

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引用次数: 0

摘要

背景和目的在肝移植（LT）候选者或受者中，代谢功能障碍相关性脂肪性肝病（MASLD）与自身免疫性肝炎（AIH）并存的情况仍然鲜为人知。方法利用联合网络器官共享数据库（2002-2022 年），我们比较了 MASLD/AIH（n = 282）、AIH（n = 5812）和 MASLD（n = 33 331）患者的等待结果和 LT 后存活率。结果MASLD/AIH组脑病和腹水发生率最高，MELD评分最高。与单纯 MASLD 相比，MASLD/AIH 患者的移植发生率更高（调整后的亚分布危险比 [aSHR] 1.64，95% CI 1.44-1.85；p < .001），候选名单移除风险更低（aSHR .30，95% CI .20-.44；p < .001）。与 AIH（患者：92% 对 91%，p < .001；移植物：89% 对 88%，p < .001）和 MASLD/AIH （患者：92% 对 90%，p = .008；移植物：89% 对 88%，p = .023）相比，MASLD 的一年 LT 后存活率更高。与MASLD（患者：63% vs. 61%，p = .68；移植物：60% vs. 59%，p = .83）和AIH（患者：63% vs. 70%，p = .07；移植物：60% vs. 64%，p = .42）相比，MASLD/AIH受者在LT后10年的存活率没有明显差异。我们的研究表明，MASLD/AIH 患者的 LT 发生率较高，辍学率较低。需要进一步的前瞻性多中心研究来验证这些发现。

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Waitlist and transplant outcomes in patients with metabolic dysfunction‐associated steatotic liver disease and autoimmune hepatitis

Background and AimsMetabolic 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.MethodsUsing 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.ResultsMASLD/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).ConclusionsOur 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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来源期刊

Liver International 医学-胃肠肝病学

CiteScore

13.90

自引率

4.50%

发文量

348

审稿时长

2 months

期刊介绍： Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.