De Novo Fatty Liver Due to Vascular Complications After Liver Transplantation

Zahmatkeshan, Mozhgan; Geramizadeh, Bita; Eshraghian, Ahad; Nikeghbalian, Saman; Bahador, Abbas; Salahi, H; Malek-Hosseini, Seyed Ali

doi:10.1016/j.transproceed.2011.01.023

Cited by 9 publications

(8 citation statements)

References 9 publications

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“…Posttransplant NAFLD in pediatric liver transplant recipients has been documented only in case series and reports69‐77 (Table 5). Four of the 19 children reported in these studies underwent transplantation for cirrhosis associated with nonalcoholic steatohepatitis (NASH) 69‐71.…”

Section: Resultsmentioning

confidence: 99%

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Posttransplant metabolic syndrome in children and adolescents after liver transplantation: A systematic review

et al. 2012

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In long-term follow-up, 18-67% of pediatric liver transplant recipients are overweight or obese— with rates varying by age and pre-transplant weight status. Similar prevalence of post-transplant obesity is seen in adults. Adults also develop post-transplant metabolic syndrome, with consequent cardiovascular disease, at rates that exceed age and gender-matched populations. Post-transplant metabolic syndrome has never been studied in pediatric liver transplant recipients—a growing population as transplant outcomes continue to improve. This paper systematically reviews the literature on each component of metabolic syndrome—obesity, hypertension, dyslipidemia, and glucose intolerance—in pediatric liver transplant recipients. Rates of obesity are similar to that of the general U.S. population of children. But hypertension, dyslipidemia, and diabetes are more common than expected for age, gender, and obesity severity in transplant recipients. Immunosuppressive medications are major contributors. Limitations of prior studies—including heterogeneous methods of diagnosis, follow-up times, and immunosuppressive regimen—hinder the analysis of risk factors. Importantly, no studies report on graft or patient outcomes associated with metabolic syndrome components after pediatric liver transplant. However, if trends in children are similar to those seen in adults, these conditions may lead to significant long-term morbidity. Further research on the prevalence, causes, and consequences of post-transplant metabolic syndrome in pediatric liver transplant is needed and ultimately will help improve long-term outcomes.

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Section: Resultsmentioning

confidence: 99%

“…One retrospective review identified 3 children who developed steatosis within the first 30 days after transplantation 77. NAFLD in these patients may have been related to overall liver dysfunction.…”

Section: Resultsmentioning

confidence: 99%

Posttransplant metabolic syndrome in children and adolescents after liver transplantation: A systematic review

et al. 2012

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“…Given the retrospective nature of most of our data collection and the lack of surveillance biopsies in all patients, this is not a definitive account of steatosis incidence or natural history after pediatric LT. Most for‐cause biopsies with steatosis were within 1‐3 months after transplant, when patients are still on corticosteroids and conditions like preservation injury or vascular complications may still be manifest . In the steatotic biopsies that met criteria for NASH on blinded review, it is key to note that features of rejection—acute and chronic—were common.…”

Section: Discussionmentioning

confidence: 99%

Hepatic steatosis after pediatric liver transplant

et al. 2017

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Rationale Hepatic steatosis develops after liver transplant in 30% of adults, and non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in non-transplanted children. However, post-transplant steatosis has been minimally studied in pediatric liver transplant recipients. We explored the prevalence, persistence, and association with chronic liver damage of hepatic steatosis in these children. Results In this single-center study of pediatric patients transplanted 1988–2015 (n=318), 31% of those with any post-transplant biopsy (n=271) had ≥1 biopsy with steatosis. Median time from transplant to first biopsy with steatosis was 0.8 months (IQR 0.3–6.5) and to last biopsy with steatosis was 5.5 months (IQR 1.0–24.5). 85% of patients with steatosis also had for-cause biopsies without steatosis. All available for-cause biopsies were re-evaluated (n=104); Of 9 biopsies that could be interpreted as NASH/Borderline NASH, with steatosis plus inflammation or ballooning, 8 also had features of cholestasis or rejection. Among 70 patients with surveillance biopsies 3.6–20.0 years post-transplant, only 1 overweight adolescent had a biopsy with NAFLD (grade 1 steatosis, mild inflammation, no ballooning or fibrosis)—despite a 30% prevalence of overweight/obesity in the cohort and 27% with steatosis on previous for-cause biopsy. Steatosis on preceding for-cause biopsy was not associated with portal (p=0.49) or perivenular fibrosis (p=0.85) on surveillance biopsy. Conclusions Hepatic steatosis commonly develops early post-transplant in children and adolescents, but it rarely persists. Biopsies that did have steatosis with NASH characteristics were all for-cause, mostly in patients with NAFLD risk factors and/or confounding causes of liver damage. Prospective studies that follow children into adulthood will be needed to evaluate if and when hepatic steatosis presents a long-term risk for pediatric liver transplant recipients.

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“…To date, however, there has been little discussion regarding NAFLD among liver transplant recipients. Some studies have demonstrated that recurrence of NAFLD is common after LT, but the incidence, risk factors, and natural history of de novo NAFLD or non‐alcoholic steatosis have not been well elucidated in this context .…”

Section: Discussionmentioning

confidence: 99%

Histologically proven non‐alcoholic fatty liver disease and clinically related factors in recipients after liver transplantation

Kim

Lee

et al. 2014

Clinical Transplantation

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Non-alcoholic fatty liver disease (NAFLD) affects a substantial proportion of the world population, and its prevalence has been increasing. The study was aimed at evaluating the prevalence and peri-transplant risk factors for post-liver transplantation (LT) NAFLD. A retrospective review was performed for adult recipients who underwent late protocol biopsy (>1 yr after LT) between August 2010 and December 2012. Hepatic steatosis was reviewed and graded by hepatopathologists, and the peri-transplant factors were analyzed for relationships to histologically proven NAFLD. Total 166 biopsies had been performed in 156 recipients. NAFLD was present in 27.1% at a mean period of 35.4 months between LT and biopsy, moderate and severe steatosis (≥33%) consisted of 28.9%. In multivariate analysis, pre-LT alcoholic cirrhosis (odds ratio [OR] 8.031, p = 0.003), obesity at biopsy (OR 3.873, p = 0.001), and preexisting donor graft steatosis (OR 3.147, p = 0.022) were significant risk factors for post-LT NAFLD. In conclusion, NAFLD represented a considerable portion of recipients, but this prevalence was not higher than those for general population. Three risk factors were significantly related to post-LT NAFLD, and recipients with those factors should be monitored for NAFLD. Furthermore, possible progression to non-alcoholic steatohepatitis (NASH) or fibrosis and metabolic syndrome should be considered in future studies.

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De Novo Fatty Liver Due to Vascular Complications After Liver Transplantation

Cited by 9 publications

References 9 publications

Posttransplant metabolic syndrome in children and adolescents after liver transplantation: A systematic review

Posttransplant metabolic syndrome in children and adolescents after liver transplantation: A systematic review

Hepatic steatosis after pediatric liver transplant

Histologically proven non‐alcoholic fatty liver disease and clinically related factors in recipients after liver transplantation

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