De-novo nonalcoholic fatty liver disease at 5 years after liver transplantation: prevalence and predictive factors

Abstract

Background and aims: Nonalcoholic fatty liver disease (NAFLD) is a long-term complication after liver transplantation. Our aims were to determine de-novo-NAFLD at 5-year post-liver transplantation and identify predictive risk factors. Methods: This was a retrospective analysis of de-novo-NAFLD at 5-year post-liver transplantation. NAFLD was defined as the radiological evidence of steatosis. Data from transplanted patients between November 2001 and May 2014 were collected. Noninvasive fibrosis scores were calculated. Predictors of de-novo NAFLD and survival were assessed by multivariate analyses and Kaplan–Meier method. Results: A total of 252 liver transplantations were evaluated after applying exclusion criteria, (78.6% men) with 54.9 years old (SD ± 9.5). Prevalence of de-novo NAFLD at 5-year post-liver transplantation was 36.1%. Cardiovascular events were presented in 19.88% and 23.08% of non-NAFLD and NAFLD patients, (P = 0.58). On multivariate analysis, male sex (OR, 5.40; P = 0.001), obesity (OR, 3.72; P = 0.017), metabolic syndrome (OR, 4.69; P < 0.001) and de-novo diabetes (OR, 2.79; P = 0.018), were predictive. Significant fibrosis (≥F2) was presented in 58–86%. The mean survival in NAFLD and control group was 166.3 and 173.6 months, respectively (P = 0 0.50). Conclusion: De-novo NAFLD at fifth-year post-liver transplantation is frequently and associated with cardiovascular comorbidity. Male sex, obesity, de-novo diabetes and metabolic syndrome were factors associated with de-novo NAFLD. A significant proportion of patients had advanced fibrosis. This group trends toward worse patients’ survival.

Extrahepatic organs in the development of non-alcoholic fatty liver disease in liver transplant patients

“…Recent studies showed relationship of NAFLD and obesity as well as other lipid-associated factors in LT background. A singlecenter retrospective study of LT recipients described the prevalence of de novo NAFLD was 36.1% of patients (37). Further multivariate analysis found predictive independent risk factors for de novo NAFLD 5-year after LT such as Regarding adipose tissue as an endocrine organ provides a new perspective to understanding the pathogenesis of NAFLD in LT setting (38).…”

De novo and recurrence of metabolic dysfunction-associated fatty liver disease after liver transplantation

“…Another study also showed that a time-dependent increase in the risk of recurrent graft steatosis approached 100% by 5 years compared to approximately 25% incidence of de novo graft steatosis in weight-matched controls who were being transplanted for primary biliary cirrhosis/primary sclerosing cholangitis or alcoholic liver cirrhosis[ 51 ]. De novo graft steatosis was found in 36.11% of 252 post LT patients after 5 years of liver transplantation in a study by Tejedor-Tejada et al [ 52 ]. Among the patients with de novo graft steatosis, significant fibrosis (F ≥ 2) was found in 85.6% with NFS, 81.9% with FIB4, 57.9% with APRI, 61.7% with AAR, and 83% with BARD after 5 years post LT.…”

“…Studies have shown worse outcomes in patients being transplanted from steatohepatitis with HCC as well as patients being re-transplanted for graft steatohepatitis[ 53 , 54 ]. De novo neoplasms were generally increased in patients with de novo graft steatosis compared to controls[ 52 ]. However, there is no literature showed an increase in the incidence of recurrent HCC in post LT patients with either de novo or recurrent graft steatosis.…”

“…The study did not show any significant difference in death and fibrosis progression between patients with biopsy-proven de novo vs recurrent steatohepatitis[ 9 ]. In a study of 252 post LT patients by Tejedor-Tejada et al [ 52 ], there is no significant difference in the medium and long-term survival between patients with de novo graft steatosis and controls[ 52 ].…”

“…Specific factors associated with CV disease in the post-transplant setting are age > 55 years old, male sex, DM, and kidney failure[ 59 ]. In a study by Tejedor-Tejada et al [ 52 ], CV events were found more frequently in patients with post LT de novo graft steatosis than controls (23.08% vs 19.88%). Similarly, de novo malignancies were found more in de novo graft steatosis group compared to control (24.18% vs 19.25%)[ 52 ]…”