De novo hepatic steatosis drives atherogenic risk in liver transplantation recipients

Abstract

Nonalcoholic fatty liver disease is associated with cardiovascular disease (CVD) in the general population. Despite a high prevalence of de novo hepatic steatosis after liver transplantation (LT), there are no data exploring the association between hepatic steatosis after LT and atherogenic risk. The aim of the study was to explore the impact of hepatic steatosis on serum atherogenic markers in liver transplantation recipients (LTRs). Biomarkers of CVD risk were compared in 89 LTRs with no known history of dyslipidemia, ischemic heart disease, or graft cirrhosis. To avoid potential confounders, LTRs on oral hypoglycemic agents, exogenous insulin, corticosteroids, or lipid‐lowering therapy were excluded. Only patients for whom histological assessment was available after LT were included in the study. Thirty‐five LTRs had de novo hepatic steatosis after LT, whereas 54 did not. Both cohorts were similar with regards to age, sex, ethnicity, and follow‐up from LT. Additionally, the traditional lipid profile was similar between the 2 cohorts. LTRs with hepatic steatosis had higher serum concentrations of small‐dense low‐density lipoprotein cholesterol (sdLDL‐C; 34.8 ± 16.9 versus 22.7 ± 11.2 mg/dL; P < 0.001), sdLDL‐C to low‐density lipoprotein cholesterol ratio (32.6 ± 11.6 versus 24.6 ± 10.2; P < 0.01), small‐dense low‐density lipoprotein particle concentration (sdLDL‐P; 770 ± 440 versus 486 ± 402 nmol/L; P < 0.01), very low density lipoprotein particle concentration (VLDL‐P; 7.90 ± 7.91 versus 3.86 ± 3.18 nmol/L; P < 0.01), and very low density lipoprotein size (VLDL‐size; 51.9 ± 6.4 versus 48.7 ± 6.3 nm; P = 0.06). LTRs with hepatic steatosis had higher serum insulin concentrations (27.8 ± 41.8 versus 11.7 ± 7.8 uU/mL; P < 0.01) but similar fasting glucose and hemoglobin A1c. Steatosis grade was directly related to sdLDL‐C, sdLDL‐P, insulin, VLDL‐P, and VLDL‐size. In multivariate analysis, the association between steatosis grade and sdLDL‐C (β = 0.03; P = 0.029), VLDL‐size (β = 0.316; P = 0.04), and low‐density lipoprotein particle size (β = –0.27; P = 0.05) was independent of sex, body mass index, age, diabetes mellitus, time from transplant, and indication for LT. In conclusion, de novo hepatic steatosis after LT is associated with atherogenic lipoproteins and independent of traditional CVD risk factors. Liver Transpl 21:1395‐1402, 2015. © 2015 AASLD.

Current status of imaging in nonalcoholic fatty liver disease

“…It has an estimated worldwide prevalence ranging from 20% to 46%, varying with study population and diagnostic criteria used[2]. In the United States, NAFLD is estimated to affect approximately 30% (100 million) of the population[3,4]. The prevalence is even higher amongst obese (70%) and diabetic (90%) individuals[5].…”

“…The prevalence is even higher amongst obese (70%) and diabetic (90%) individuals[5]. NAFLD-related liver impairment is expected to be the dominant cause of end stage liver disease (ESLD) requiring transplantation in the United States by 2020[4]. …”

Liver Transplantation: the Role of Metabolic Syndrome

“…Emerging data suggest that the traditional lipid profile fails to capture the atherogenic risk and more detailed lipoprotein profiles may be useful [79•]. Additionally, presence of hepatic steatosis and cyclosporine (compared to tacrolimus) tends to worsen the atherogenic profile further [80].…”

Non-invasive diagnosis of non-alcoholic fatty liver disease (NAFLD) using ultrasound image echogenicity

“…As of today, it has an estimated worldwide prevalence of 25% to 45% [1, 2]. In the United States, NAFLD afflicts roughly 30% of the population, and by 2020, NAFLD is projected to be the leading indicator, and cause, of liver transplantations in the world [3, 4]. Moreover, NAFLD has been recognized as an independent cardiovascular disease risk factor and has been associated with severe metabolic impairments such as insulin resistance, hypertension, obesity, and Type 2 diabetes.…”