Reuters Health Information: NAFLD recurs in most patients who undergo transplant for NASH
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
Nearly 30% of people in the U.S. have NAFLD, according to
the researchers. NASH is a clinically aggressive subtype of
NAFLD, which �went 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.
�The amount of information out there on post-transplant
fatty liver disease is very limited,� he added. �We 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
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
Immunosuppression is associated with metabolic
complications, and reducing immunosuppression could help
minimize these complications, Dr. Siddiqui noted.