S1143 Noninvasive Assessment of NAFLD in Potential Kidney Transplant Recipients

Abstract

Introduction: Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease among US adults. Risk factors (RF) for NAFLD including diabetes mellitus (DM) and hypertension (HTN), also increase the risk of chronic kidney disease (CKD). Our aim is to assess the prevalence of NAFLD and identify RF and predictors for NAFLD in patients listed for Kidney Transplant (KT). We also use noninvasive tests (NITs) to assess the prevalence of at least significant fibrosis in the NAFLD group. Methods: We performed a retrospective chart review on patients listed for KT. We included all adult patients listed for KT between 03/2015-08/2019. Exclusion criteria included a history of prior liver transplant, listed for simultaneous liver kidney transplant, and lack of available liver imaging in the past 5 years. We excluded patients with a history of either nonNAFLD liver disease or excessive alcohol use from the NAFLD group, but included them in the nonNAFLD analysis. We collected data on demographics, comorbidities, etiology of CKD, liver chemistries, and imaging of the liver. Most patients listed for KT after 2018 had a LE. FIB-4 score was calculated for all NAFLD patients. Results: 204 patients were included. 22.5% of patients were found to have NAFLD based on imaging describing an echogenic liver or hepatic steatosis. See table 1. On univariate analysis, a history of DM, metabolic syndrome (MS), DM as cause of CKD, and BMI were significantly associated with NAFLD (all p< 0.05). On multivariate analysis, ALT level was the only independent predictor of NAFLD (p< 0.05). The mean FIB4 score in the NAFLD group was 1.43. 67% of the NAFLD group had a FIB-4 < 1.45. 28.3% of the NAFLD group had an indeterminate FIB-4 score of >1.45 but < 3.25. 4.3% of the NAFLD group had a FIB-4 score >3.25, likely having advanced fibrosis. 56% of NAFLD patients had an available liver stiffness (LS) score. Of the NAFLD patients with LS scores, 11.5% was consistent with F2 fibrosis and 11.5% with ≥F3 fibrosis. Conclusion: NAFLD prevalence in patients listed for KT is similar to that of US adults, but this patient group may have a higher prevalence of at least significant fibrosis. Patients listed for KT who have a high BMI or history of MS or DM, especially if they have an abnormal ALT, should be evaluated for NAFLD. Potential KT recipients with NAFLD should have NITs such as a FIB-4 score or LE to assess for advanced fibrosis. Further studies are required to confirm these findings.Table 1.: Percentage of patients meeting inclusion criteria as compared by whether they were accepted for full assessment or not.