Recurrence of Non Alcoholic Fatty Liver Disease Following Liver Transplantation
FL Chang, J Mellinger, P Dureja, G Avey, A D'Alessandro, J Mezrich, A Said, R Agni. University of Wisconsin School of Medicine and Public Health, Madison, WI
Background: Non alcoholic liver disease (NAFLD) is a common reason for liver transplantation. The current study is undertaken to study recurrence of NAFLD in a large cohort of adult liver transplant recipients and assess recurrence-related factors
Design: Consecutive patients transplanted for NAFLD / cryptogenic cirrhosis from 1993 to 2005 were studied. NAFLD recurrence was defined histologically with radiological confirmation Liver biopsies were assessed by two blinded pathologists for steatosis, steatohepatitis, and fibrosis using NASH-CRN scoring and Brunt system.
Results: 88 consecutive transplant recipients met selection criteria, including 50 males and 38 females, with an average age of 58 years. Pretransplant diabetes was present in 39 (45%) and in 62 (71%) posttransplant. Biopsy recurrence of NAFLD was documented in 29 of 47 patients (62%). Of the 29, steatosis alone was present in 19 (65%), with steatohepatitis in 10. Hepatic fibrosis was at stage 1 in 3 of 29 (10%), stage 2 in 7 (24%) and stage 3-4 in 2. Post transplant survival was similar among those with NAFLD recurrence and those without (P=0.33). The most significant factors associated with post-transplant NAFLD recurrence were pre-transplant diabetes (OR 5.26, 95% CI 1.25-22.2, P=0.03) and post-transplant diabetes (OR 4.41, 95% CI 1.20-16.14, P=0.03). Other predictors of recurrence included high triglyceride levels at 6 (P=0.01) and 12 months (P=0.02) ; average triglyceride levels at 12 months were 328 mg/dl in recipients with NAFLD recurrence and 189 mg/dl in those without NAFLD recurrence. Prednisone dose at 6 months was higher in patients with NAFLD recurrence (11.8 mg/day) than in patients without recurrence (7.7 mg/day), P=0.03. Pre or post transplant hypertension, non-triglyceride lipids, insulin dose and post transplant choice of calcineurin inhibitor were not associated with NAFLD recurrence
Conclusions: Post-transplant recurrent NAFLD is common. However it is mild in most patients and does not lead to reduced survival. Pretransplant diabetes, post transplant diabetes, high triglyceride levels and higher average steroid doses are associated with NAFLD recurrence.
Category: Liver & Pancreas
Tuesday, March 23, 2010 9:30 AM
Poster Session III # 244, Tuesday Morning