Development of nonalcoholic fatty liver disease after orthotopic liver transplantation for cryptogenic cirrhosis

• Published in: Liver transplantation Vol. 7; no. 4; pp. 363 - 373
• Main Authors: Contos, Melissa J., Cales, Wendy, Sterling, Richard K., Luketic, Velimir A., Shiffman, Mitchell L., Mills, A.Scott, Fisher, Robert A., Ham, John, Sanyal, Arun J.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.04.2001; W.B. Saunders
• Subjects: Adult; Disease Progression; Fatty Liver - etiology; Fatty Liver - pathology; Female; Humans; Liver - pathology; Liver Cirrhosis - surgery; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Retrospective Studies
• ISSN: 1527-6465; 1527-6473
• DOI: 10.1053/jlts.2001.23011

Many subjects with cryptogenic cirrhosis have underlying nonalcoholic steatohepatitis (NASH). The natural history of NASH-related cryptogenic cirrhosis after orthotopic liver transplantation (OLT) is not well defined. A primarily retrospective study of patients with the clinical histological phenotype of NASH-related cirrhosis undergoing OLT was performed. Data were compared with 2 sets of age- and weight-matched controls with (1) primary biliary cirrhosis or primary sclerosing cholangitis or (2) alcoholic liver disease. After OLT, all patients were managed by a standard immunosuppressive protocol. Liver biopsies were performed at 6 and 12 months after OLT and at 1- to 2-year intervals thereafter, as well as when liver enzyme levels were elevated enough to warrant diagnostic biopsy. Twenty-seven subjects with cryptogenic cirrhosis and a clinical histological phenotype of NASH and 3 patients with a long-standing diagnosis of NASH before OLT were included. The 30-day perioperative mortality was 1 in 30 patients. During a median follow-up of 3.5 ± 2.7 years, 2 additional patients died of sepsis. There was a time-dependent increase in the risk for allograft steatosis that approached 100% by 5 years compared with only an approximately 25% incidence of steatosis in the control groups ( P < .009, log-rank test). On multivariate analysis, only the cumulative steroid dose correlated with time to development of allograft steatosis. Three patients developed histological progression from hepatic steatosis to steatohepatitis. Of these, 1 patient developed progressive fibrosis. Four patients experienced at least 1 episode of acute cellular rejection; however, no patient developed chronic rejection or graft failure. In conclusion, nonalcoholic fatty liver disease occurs frequently after OLT in patients with the phenotype of NASH-related cirrhosis. Despite the frequent histological recurrence of disease, clinical outcomes are similar to those of other groups of patients undergoing OLT. ( Liver Transpl 2001;7:363-373.)