Graft fibrosis and recipient survival in postorthotopic liver transplant nonalcoholic fatty liver disease

Background and purpose Both de-novo and recurrent nonalcoholic fatty liver disease (NAFLD) are increasingly being reported in postorthotopic liver transplant (post-OLT) patients. We evaluated graft fibrosis and recipient survival in post-OLT steatosis and steatohepatitis. Patients and Methods On the basis of post-OLT liver biopsy results, post-OLT patients were divided into control (without nonalcoholic fatty liver disease), post-OLT steatosis, or post-OLT nonalcoholic steatohepatitis (NASH). The extent of graft fibrosis and patient survival were compared among the three groups. Results A total of 123 OLT recipients were included with a 12-month median follow-up (2.07-52.83). They underwent 181 post-OLT liver biopsies, with 41.6% having two or more biopsies. Post-OLT steatosis and post-OLT NASH were observed in 10.6 and 18.7%, respectively. Independent risk factors were sex, pre-OLT NASH, and pre-OLT obesity for post-OLT steatosis and pre-OLT NASH and pre-OLT obesity for post-OLT NASH. The rate of moderate-to-severe fibrosis (3-4/4) was 0% in post-OLT steatosis, 13% in post-OLT NASH, and 17.2% in the control. Twenty patients died and age was the only independent predictor of mortality. All deaths in the post-OLT NASH (9%) occurred within 1 year of OLT and none was due to graft loss. No mortality was observed in the post-OLT steatosis group. Conclusion Pre-OLT NASH and obesity are independent risk factors for post-OLT NASH. Within the 12-week median follow-up of post-OLT patients, significant graft fibrosis was observed in 13% of the patients with post-OLT NASH but not in post-OLT steatosis. Our data suggest that prevention, in high-risk patients, and management of post-OLT NASH should start as early as possible after OLT.