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A non-interventional study of the genetic polymorphisms of NOD2 associated with increased mortality in non-alcoholic liver transplant patients

Fuat Hakan Saner1*, Knut Nowak1, Dieter Hoyer1, Peter Rath2, Ali Canbay3, Andreas Paul1, Michael Koldehoff4 and Ahmet Elmaağaclı4

Author Affiliations

1 Department of General- Visceral- and Transplant Surgery, University Duisburg-Essen, Hufelandstr 55, 45 122 Essen, Germany

2 Department of Microbiology, University Duisburg-Essen, 45 122 Essen, Germany

3 Department of Gastroenterology and Hepatology, University Duisburg-Essen, 45 122 Essen, Germany

4 Department of Bone Marrow Transplantation, University Duisburg-Essen, 45 122 Essen, Germany

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BMC Gastroenterology 2014, 14:4  doi:10.1186/1471-230X-14-4

Published: 6 January 2014



Infections after liver transplantation are the main cause of death in the first year. Recent reports indicate that NOD2 gene mutations increase the risk for inflammatory bowl disease and the severity of graft-versus-host disease in bone marrow transplant patients. Data on polymorphisms in liver transplant patients are sparse. We analyzed 13 single-nucleotide polymorphisms (SNPs) of 13 different gene variants including the SNPs of NOD2 genes from liver recipients. The aim of the study was to evaluate the impact of the SNPs on dialysis-dependent kidney failure, the incidence of infections and patient survival.


During a period of 20-months, 231 patients were recruited in this non-interventional, prospective study. Thirteen different SNPs and their impact on the patients’ survival, infection rate, and use of dialysis were assessed.


NOD 2 wildtype genes were protective with respect to the survival of non-alcoholic, cirrhotic transplant patients (3 year survival: 66.8% wildtype vs. 42.6% gene mutation, p = 0.026). This effect was not observed in alcoholic transplant recipients.

The incidence of dialysis-dependent kidney failure and infection in the liver transplant patients was not influenced by NOD 2 gene polymorphisms. No effect was noted in the remaining 12 SNPs.

Patients with early allograft dysfunction experienced significantly more infections, required dialysis and had significantly worse survival.

In contrast, the donor-risk-index had no impact on the infection rate, use of dialysis or survival.


NOD2 gene variants seem to play a key role in non-alcoholic, liver transplant recipients. However these data should be validated in a larger cohort.