Characteristics and risk factors of fatty liver disease development and nonalcoholic steatohepatitis recurrence after liver transplantation

Abstract

Introduction: Nonalcoholic steatohepatitis (NASH), which is a common and increasing indication for liver transplantation (LT), is known to recur after LT. Since the recurrence of NASH can lead to graft failure, the identification of predictive factors and preventive strategies need to be implemented. Method: We retrospectively identified 694 consecutive patients who had undergone LT at Karolinska University Hospital between June 2007 and February 2017. Of these, 95 patients who received LT for NASH or alcoholic liver disease (ALD) as a primary indication were included. Peritransplant characteristics and histological findings 1 year post-LT among NASH patients were evaluated in comparison with ALD patients. Risk factors of post-LT fatty liver disease development and NASH recurrence were assessed. Result: Among 27 NASH patients, pre-LT body mass index (BMI) was higher (31.3 vs. 28.6, p=0.0095) and pre-LT diabetes was more prevalent than in ALD patients (p<0.0001). The difference of BMI persisted at 3 months and 1 year after LT. There were no differences between the groups regarding histopathological findings including the degree of steatosis and fibrosis in 1-year biopsy. In multivariate analysis, recipient age and 1-year BMI were independent risk factors for post-LT fatty liver disease development. Regarding predictive factors of NASH recurrence, the prevalence of pre-LT insulin dependent diabetes was significantly higher in patients who developed NASH recurrence than those who did not. The increase of HbA1c at 1-year post-LT check-up was higher in patients who developed recurrence than those who did not, although the difference did not reach statistical significance (Δ 15 vs. 5 mmol/mol, p=0.051). Conclusion: The results of this study suggests that insulin dependent diabetes has detrimental effects on NASH recurrence following LT. Optimal glycemic control should be recommended, but studies are needed to prove its preventive effect on NASH recurrence.