NAFLD recurs in most patients who undergo transplant for NASH

Last Updated: 2017-04-03

By Anne Harding

NEW YORK (Reuters Health) - Most patients who undergo transplantation for nonalcoholic steatohepatitis (NASH) will develop nonalcoholic fatty liver disease (NAFLD) in the transplanted organ, new research shows.

However, patients with NAFLD or NASH recurrence did not seem to be at increased mortality risk, Dr. M. Shadab Siddiqui of Virginia Commonwealth University in Richmond and colleagues found. Their findings were published online March 15 in Transplantation.

Nearly 30% of people in the U.S. have NAFLD, according to the researchers. NASH is a clinically aggressive subtype of NAFLD, which �€œwent from being an insignificant cause of liver failure to the leading cause of liver cirrhosis in the country,�€ Dr. Siddiqui told Reuters Health in a telephone interview.

�€œThe amount of information out there on post-transplant fatty liver disease is very limited,�€ he added. �€œWe really don�€™t understand this disease well.�€

In the new study, the researchers looked at long-term outcomes in 103 patients who underwent liver transplantation (LT) for NASH at their institution.

Thirty-four underwent a liver biopsy a median 47 months after LT. Thirty of these patients (88%) had recurrent NAFLD, and 41% had NASH.

Fasting serum glucose and triglycerides were significantly higher in the patients with recurrent disease. All female patients developed recurrent NAFLD, compared to 75% of males. While most patients had no fibrosis or mild fibrosis, about one in five had bridging fibrosis.

Fifty-six of the patients had transient elastography (TE), a median 75 months after LT. Forty-nine (88%) had hepatic steatosis. Serum HDL was inversely related to hepatic steatosis. Thirty-two, or 43%, had fibrosis, while 15 (27%) had advanced fibrosis.

Body mass index (BMI), serum triglycerides and use of oral hypoglycemic agents were all independently associated with advanced fibrosis based on TE. Patients with recurrent NAFLD had lower serum HDL and higher triglycerides, and were more likely to have diabetes. However there was no association between ALT or AST and NAFLD recurrence.

Thirty-two patients died. There was no association between recurrent NAFLD or NASH and mortality. Leading causes of death were malignancy (25%), infectious complications (25%) and cardiovascular complications (22%). Three patients died due to recurrent graft cirrhosis, a mean 73 months after LT.

Pretransplant obesity was significantly associated with increased mortality risk (odds ratio, 2.9), as was age over 60 (OR, 4.0). After transplant, serum LDL-cholesterol, triglycerides and total cholesterol were all associated with tiny, though statistically significant, increases in mortality risk, while use of statins, fish oil or anti-hypertensive medications was associated with a significantly reduced mortality risk.

Immunosuppression is associated with metabolic complications, and reducing immunosuppression could help minimize these complications, Dr. Siddiqui noted.

SOURCE: http://bit.ly/2n3q0Pf

Transplantation 2017.