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

Abstract

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.

NAFLD and liver transplantation: Current burden and expected challenges

“…Obesity and donor graft steatosis seem to be also associated with a higher risk of NAFLD occurrence and suggests for a role of genetic predisposition [114,115]. This hypothesis has been confirmed by a recent study demonstrating that recipient’s but not donor’s PNPLA3 genotype was associated with increased risk of steatosis, supporting the role of extrahepatic (adipocyte) PNPLA3 activity in liver fat accumulation [116].…”

“…Although most of these patients have mild histological lesions, recurrent NASH may occur in 10%–33% of patients and advanced fibrosis in 5–10% (Table 3) [82–84,108–112]. De novo NAFLD occurs in 20%–30% of patients, but only a minority (5%–10%) will develop NASH and advanced fibrosis (2%–4%) (Table 3) [113–115]. However, most of these studies have important limitations: retrospective design, variable and short follow-up period, small number of patients and an important heterogeneity in patients’ selection and histological diagnosis of NAFLD.…”

Effect of PNPLA3 I148M polymorphism on histologically proven non‐alcoholic fatty liver disease in liver transplant recipients

“…However, NAFLD in LT recipients is equivocal. Very little has been published regarding this condition with increasing numbers of LT recipients …”

NASH Cirrhosis - the New Burden in Liver Transplantation: How Should It Be Managed?

“…For example, donor steatosis is associated with a threefold increased risk of post-transplant NAFLD [37]. …”