Nonalcoholic steatohepatitis in posttransplantation liver: Review article

Abstract

Introduction: Nonalcoholic steatohepatitis (NASH) associated or not with cirrhosis is the third leading indication for liver transplantation (LT) around the world. After transplants, NASH has a high prevalence and occurs as both recurrent and de novo manifestations. De novo NASH can also occur in allografts of patients transplanted for non-NASH liver disease. Objective: To evaluate recurrent or de novo NASH in post-LT patients. Method: A literature review was performed using search engines of indexed scientific material, including Medline (by PubMed), Scielo and Lilacs, to identify articles published in Portuguese and English until August 2016. Eligible studies included: place and year of publication, prevalence, clinical characteristics, risk factors and survival. Results: A total of 110 articles were identified and 63 were selected. Most of the studies evaluated recurrence and survival after LT. Survival reached 90-100% in 1 year and 52-100% in 5 years. Recurrence of NAFLD (steatosis) was described in 15-100% and NASH, in 4-71%. NAFLD and de novo NASH were observed in 18-67% and 3-17%, respectively. Metabolic syndrome, diabetes mellitus, dyslipidemia and hypertension were seen in 45-58%, 18-59%, 25-66% and 52-82%, respectively. Conclusion: After liver transplants, patients present a high prevalence of recurrent and de novo NASH. They also show a high frequence of metabolic disorders. Nevertheless, these alterations seem not to influence patient survival.

Clinical considerations in the management of non-alcoholic steatohepatitis cirrhosis pre- and post-transplant: A multi-system challenge

“…No significant difference in 5-year graft loss or mortality was observed, suggesting that NASH itself is not an independent risk factor for mortality. In a meta-analysis of 16 studies on post-LT survival with NASH, most studies found no significant survival difference was found between NASH and other etiologies of liver disease[ 149 ]. Another study documented superior survival in NASH patients compared with LT recipients for other causes for transplantation, such as HCC, hepatitis C or alcoholic liver disease[ 150 ].…”

“…Despite lack of non-inferior survival data, the overall incidence of morbidity after LT appears to be higher for NASH recipients than others[ 156 ]. Metabolic syndrome develops in up to 50% of patients after LT for NASH; however, no significant difference between NASH and other etiologies of liver disease has been shown[ 149 ]. Nonetheless, it is postulated that LT recipients with NASH have a predisposing metabolic milieu that persists despite transplantation, and it may be further modulated by steroid-based immunosuppressive regimens.…”

Magnitude of Nonalcoholic Fatty Liver Disease: Western Perspective

“…117,118 NAFLD recurrence after liver transplantation is a vexing problem, and its incidence has been reported to be anywhere between 15 and 100%. 119 Post-transplant metabolic syndrome has multifactorial etiologies, although adverse effect profile of immunosuppressive agents (steroids, calcineurin inhibitors, mTOR inhibitors, and so on) and lack of adherence to lifestyle modifications are its major contributors. Physicians ought to educate their patients on the pivotal role of diet and exercise after liver transplantation and attempt risk factor modification (e.g., control of high blood pressure, diabetes, dyslipidemia, obesity, CKD) with appropriate counseling and pharmacotherapy.…”

Mutual interaction between endoplasmic reticulum and mitochondria in nonalcoholic fatty liver disease

“…NAFLD is divided into two major subtypes: nonalcoholic fatty liver (NAFL also called simple steatosis), which is a form of nonprogressive NAFLD that rarely develops into cirrhosis, and nonalcoholic steatohepatitis (NASH), a progressive and aggressive form of NAFLD. Long-term NASH is highly likely to progress to cirrhosis and hepatocellular carcinoma (HCC) [1]. NASH is considered an intermediate stage of liver damage and the most extreme form of NAFLD [2].…”

“…1 Spectrum of NAFLD progression. The development of NAFLD is divided into four stages: simple steatosis (or NAFL), NASH, liver cirrhosis, and eventually HCC [1]. Factors that cause simple steatosis include Western HFHSDs, obesity, T2DM (particularly the associated IR), and other metabolic diseases.…”