Incidence and Risks for Nonalcoholic Fatty Liver Disease and Steatohepatitis Post-liver Transplant: Systematic Review and Meta-analysis

Abstract

Background. The true incidence and unique risk factors for recurrent and de novo nonalcoholic fatty liver (NAFLD) and nonalcoholic steatohepatitis (NASH) post-liver transplant (LT) remain poorly characterized. We aimed to identify the incidence and risk factors for recurrent and de novo NAFLD/NASH post-LT. Methods. MEDLINE via PubMed, Embase, Scopus, and CINAHL were searched for studies from 2000 to 2018. Risk of bias was adjudicated using the Newcastle-Ottawa Scale. Results. Seventeen studies representing 2378 patients were included. All were retrospective analyses of patients with post-LT liver biopsies, with the exception of 2 studies that used imaging for outcome assessment. Seven studies evaluated occurrence of recurrent NAFLD/NASH, 3 evaluated de novo occurrence, and 7 evaluated both recurrent and de novo. In studies at generally high or moderate risk of bias, mean 1-, 3-, and ≥5-year incidence rates may be 59%, 57%, and 82% for recurrent NAFLD; 67%, 40%, and 78% for de novo NAFLD; 53%, 57.4%, and 38% for recurrent NASH; and 13%, 16%, and 17% for de novo NASH. Multivariate analysis demonstrated that post-LT body mass index (summarized odds ratio = 1.27) and hyperlipidemia were the most consistent predictors of outcomes. Conclusions. There is low confidence in the incidence of recurrent and de novo NAFLD and NASH after LT due to study heterogeneity. Recurrent and de novo NAFLD may occur in over half of recipients as soon as 1 year after LT. NASH recurs in most patients after LT, whereas de novo NASH occurs rarely. NAFLD/NASH after LT is associated with metabolic risk factors.

NAFLD and liver transplantation: Disease burden, current management and future challenges

“…22 Considering all the metabolic complications potentially affecting patients after LT, the risk of developing post-transplant NAFLD/NASH can be considered high, although studies published on this topic are based on small sample sizes, with heterogeneous definitions of disease recurrence. 23 In a meta-analysis, the mean 1-, 3-, and 5-year incidence rates of recurrent and de novo NAFLD were 59%, 57%, 82% and 67%, 40%, 78%, respectively. Conversely, the incidence of post-transplant NASH was significantly higher when considering recurrent NASH (53%, 57.4%, and 38% at 1, 3, 5 years after LT, respectively) compared with de novo NASH (13%, 16%, and 17%, respectively).…”

“…Conversely, the incidence of post-transplant NASH was significantly higher when considering recurrent NASH (53%, 57.4%, and 38% at 1, 3, 5 years after LT, respectively) compared with de novo NASH (13%, 16%, and 17%, respectively). 23 Regarding advanced liver disease, the reported rates of cirrhosis in patients with recurrent or de novo NAFLD are around 11%-14% and 1% at 5 years post-LT, respectively. 23 Post-transplant high BMI, post-transplant hyperlipidaemia, and a history of alcohol abuse are considered predictors of post-LT graft steatosis.…”

“…23 Regarding advanced liver disease, the reported rates of cirrhosis in patients with recurrent or de novo NAFLD are around 11%-14% and 1% at 5 years post-LT, respectively. 23 Post-transplant high BMI, post-transplant hyperlipidaemia, and a history of alcohol abuse are considered predictors of post-LT graft steatosis. 23 Nevertheless, although allograft steatosis is extremely frequent, it does not seem to impact severely on post-LT outcomes.…”

“…23 Post-transplant high BMI, post-transplant hyperlipidaemia, and a history of alcohol abuse are considered predictors of post-LT graft steatosis. 23 Nevertheless, although allograft steatosis is extremely frequent, it does not seem to impact severely on post-LT outcomes. 24 Conversely, the effect of histologically proven NASH on post-LT outcomes might be different from simple steatosis, representing a strong predictor of lower long-term survival.…”

Lebertransplantation in der Schweiz 2020

“…Jedoch auch nach Transplantation aufgrund einer NAFLD-assoziierten Leberzirrhose kann es zu einem Rezidiv kommen. In einer rezenten Metaanalyse konnte gezeigt werden, dass die 5-Jahres-Inzidenz der rekurrenten NAFLD bei 82 % liegt und mit einer erhöhten Mortalität einhergehen kann [13]. Eine Kontrolle der metabolischen Risikofaktoren erscheint daher obligat.…”