De novo nonalcoholic fatty liver disease after liver transplantation

Abstract

Hepatic steatosis is a recognized problem in patients after orthotopic liver transplant (OLT). However, de novo development of nonalcoholic fatty liver disease (NAFLD) has not been well described. The aim of this study was to determine the prevalence and predictors of de novo NAFLD after OLT. A retrospective analysis was performed on 68 OLT patients with donor liver biopsies and posttransplantation liver biopsies. Individual medical charts were reviewed for demographics, indication for OLT, serial histology reports, genotypes for hepatitis C, comorbid conditions, and medications. Liver biopsies were reviewed blindly and graded according to the Brunt Scoring System. Multivariate logistic regression analysis was used to study the risk factors for developing NAFLD. The interval time from OLT to subsequent follow-up liver biopsy was 28 +/- 18 months. A total of 12 patients (18%) developed de novo NAFLD, and 6 (9%) developed de novo NASH. The regression model indicated that the use of angiotensin-converting enzyme inhibitors (ACE-I) was associated with a reduced risk of developing NAFLD after OLT (odds ratio, 0.09; 95% confidence interval, 0.010-0.92; P = 0.042). Increase in body mass index (BMI) of greater than 10% after OLT was associated with a higher risk of developing NAFLD (odds ratio, 19.38; 95% confidence interval, 3.50-107.40; P = 0.001). In conclusion, de novo NAFLD is common in the post-OLT setting, with a significant association with weight gain after transplant. The use of an ACE-I may reduce the risk of developing post-OLT NAFLD.

Prevalence and risk factors of steatosis after liver transplantation and patient outcomes

“…This is higher than the previously reported prevalence of 18%-40% in LT recipients. (11)(12)(13) Although the most frequent indication for LT in our study group was alcoholic cirrhosis (26.3%), which poses an increased risk of posttransplant steatosis, another study with an even higher proportion of patients with alcoholic cirrhosis reported a lower prevalence of posttransplant steatosis. (11) The high prevalence of posttransplant overweight/obesity (52.4%), hypertriglyceridemia (55.7%), and DM (29.4%) among our patients may explain the high prevalence of steatosis.…”

“…(10) Posttransplant NAFLD affects 18%-40% of liver transplantation (LT) recipients (11)(12)(13) and even 39%-70% (14,15) of those transplanted for NAFLD-related cirrhosis. Risk factors of posttransplant NAFLD include pretransplant and posttransplant obesity, (11)(12)(13) alcoholic cirrhosis as an indication for LT, posttransplant DM, hyperlipidemia, hypertension, tacrolimus (FK-506) administration, and pretransplant graft steatosis. (11) In a study by Finkenstedt et al, (16) the PNPLA3 genotype of the recipient (but not the donor) was associated with the development of posttransplant steatosis.…”

Steatosis after liver transplantation: Is it really benign?

“…In recent studies, the development of de novo steatosis does not only depend on the risk factors reported for recurrent NAFLD/NASH but also on patient obesity at the time of liver biopsy, tacrolimus-based immunosuppression, alcoholic liver disease as the primary indication for LT, and pretransplant liver graft steatosis. (5,6) There are very few studies addressing the histological evolution and longterm natural history of NAFLD after LT, regardless of recurrent or de novo steatosis. In particular, the clinical impact of graft steatosis on the longterm outcome of LT recipients remains unclear.…”

Excesso de peso em pacientes submetidos ao transplante hepático

“…Obesity can also affect the graft in the late postoperative period. In patients with general indications for liver transplantation, the incidence of steatosis ranges from 18% 43 to 40% 44 and the incidence of non-alcoholic steatohepatitis, from 9% 43 to 13% 44 . Excess weight has been considered a risk factor for such types of involvement.…”