Frequency of nonalcoholic steatohepatitis as a cause of advanced liver disease

Abstract

Although nonalcoholic steatohepatitis (NASH) has generally been considered a benign condition, the increasing prevalence and severity of obesity has heightened concerns about the frequency with which NASH progresses to end-stage liver disease. The aim of this study is to determine the frequency, clinical features, and posttransplantation history of decompensated liver disease secondary to NASH. The frequency of NASH as a cause of end-stage liver disease was prospectively determined in patients evaluated for liver transplantation. NASH was considered to be the primary cause of liver disease in patients who had histological evidence of steatohepatitis and in whom chronic liver diseases other than NASH were excluded. Posttransplantation histological characteristics were also determined in patients with NASH and compared with those of patients with pretransplantation diagnoses of cholestatic liver diseases, alcoholic disease, and hepatitis C. Of 1,207 patients evaluated for liver transplantation during the study period, 31 patients (2.6%) had NASH as the primary cause of liver disease. In the same period, 546 liver transplantations were performed, 16 of which (2.9%) were for end-stage disease secondary to NASH. Posttransplantation steatosis was seen in 60% of transplant recipients with NASH versus 5% of those with cholestatic disease, 15% of those with alcoholic disease, and 15% of those with hepatitis C. Steatohepatitis recurred in 33% of transplant recipients with NASH, with progression to cirrhosis in 12.5%. NASH can progress to end-stage liver disease in a minority of affected patients and was the primary cause of liver disease in 2.9% of patients evaluated for liver transplantation at our center. Recurrence of steatosis and NASH is frequent and can be severe after liver transplantation. (Liver Transpl 2001;7:608-614.)

Obesity and liver disease

“…Of 1207 patients evaluated for liver transplantation, 31 patients (2.6%) had NASH as the primary cause of liver disease. 84 These observations demonstrate that NASH can progress to endstage liver disease in a minority of affected patients. In a series of 90 patients with NASH, 28% of subjects had cirrhosis and almost half of those had complications of portal hypertension, necessitating liver transplantation.…”

Histopathology of Non-Alcoholic Fatty Liver Disease

“…Moreover, anti-rejection medications, in particular steroid treatment and cyclosporine, are known risks for fatty liver development in the allograft, probably by affecting diabetogenic pathways [51,138] . Therefore, the occurrence of NASH in an allograft liver of a patient transplanted for "cryptogenic cirrhosis" does not justify attribution of the original disease to "burnedout" NASH without appropriate clinico-pathological correlation [139][140][141] .…”

Efflux Transporter Expression and Acetaminophen Metabolite Excretion Are Altered in Rodent Models of Nonalcoholic Fatty Liver Disease

“…Histologic features independently associated with the diagnosis of NASH in human biopsies include hepatic steatosis, hepatocyte ballooning, lobular inflammation, Mallory's hyaline, and perisinusoidal fibrosis. Moreover, NASH has the potential to advance to cirrhosis requiring liver transplant (Powell et al, 1990;Abdelmalek et al, 1995;Charlton et al, 2001;Caldwell and Hespenheide, 2002). A recent overview of clinical data estimated that NAFLD and NASH affect 17 to 33% and 5.7 to 17% of American adults, respectively.…”