Nonalcoholic fatty liver disease increases the risk of hepatocellular carcinoma in patients with alcohol-associated cirrhosis awaiting liver transplants.

Abstract

BACKGROUND & AIMS:

Many patients with alcohol-associated cirrhosis also have diabetes, obesity, or insulin resistance-mediated steatosis, but little is known about how these disorders affect the severity of liver disease. We analyzed the prevalence and prognostic implications of metabolic risk factors (MRFs) such as overweight, diabetes, dyslipidemia, and hypertension in patients with alcohol-associated cirrhosis awaiting liver transplants.

METHODS:

We performed a retrospective study of 110 patients with alcohol-associated cirrhosis (77% male; mean age, 55 y; 71% with >6 mo of abstinence) who received liver transplants at a single center in Paris, France, from 2000 through 2013. We collected data on previous exposure to MRFs, steatosis (>10% in the explant), and histologically confirmed hepatocellular carcinoma (HCC).

RESULTS:

HCC was detected in explants from 29 patients (26%). Steatosis was detected in explants from 47 patients (70% were abstinent for ≥6 mo); 50% had a history of overweight or type 2 diabetes. Fifty-two patients (47%) had a history of MRFs and therefore were at risk for nonalcoholic fatty liver disease. A higher proportion of patients with MRF had HCC than those without MRF (46% vs 9%; P < .001). A previous history of overweight or type 2 diabetes significantly increased the risk for HCC (odds ratio, 6.23; 95% confidence interval [CI], 2.47-15.76, and odds ratio, 4.63; 95% CI, 1.87-11.47, respectively; P < .001). MRF, but not steatosis, was associated with the development of HCC (odds ratio, 11.76; 95% CI, 2.60-53; P = .001) independent of age, sex, amount of alcohol intake, or severity of liver disease.

CONCLUSIONS:

Patients with alcohol-associated cirrhosis who received transplants frequently also had nonalcoholic fatty liver disease. MRFs, particularly overweight, obesity, and type 2 diabetes, significantly increase the risk of HCC.

• Authors: Raluca Pais, Pascal Lebray, Geraldine Rousseau, Frédéric Charlotte, Ghizlaine Esselma, Eric Savier, Dominique Thabut, Marika Rudler, Daniel Eyraud, Corinne Vezinet, Jean-Michel Siksik, Jean-Christophe Vaillant, Laurent Hannoun, Thierry Poynard, Vlad Ratziu
• Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 13 Issue 5 Pg. 992-9.e2 (May 2015) ISSN: 1542-7714 [Electronic] United States
• PMID: 25459558 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Carcinoma, Hepatocellular (epidemiology)
• Diabetes Mellitus, Type 2 (complications, epidemiology)
• Fatty Liver (complications, epidemiology)
• Female
• France (epidemiology)
• Humans
• Liver Cirrhosis, Alcoholic (complications)
• Liver Neoplasms (epidemiology)
• Male
• Middle Aged
• Non-alcoholic Fatty Liver Disease (complications)
• Obesity (complications, epidemiology)
• Paris
• Prevalence
• Retrospective Studies
• Risk Assessment