Faculty Collaboration Database

Nonalcoholic steatohepatitis recurrence and rate of fibrosis progression following liver transplantation. Eur J Gastroenterol Hepatol 2017 Apr;29(4):481-487

Date

03/03/2017

Pubmed ID

28253211

DOI

10.1097/MEG.0000000000000820

Scopus ID

2-s2.0-85014405487 (requires institutional sign-in at Scopus site)   32 Citations

Abstract

BACKGROUND: Nonalcoholic steatohepatitis (NASH) is known to recur following liver transplantation (LT). Metabolic risk factors increase with immunosuppression. However, the rate of fibrosis progression following LT for NASH while on immunosuppression is less clear.

AIM: The incidences of steatosis, NASH, and fibrosis following LT for NASH were quantified and compared with those transplanted for alcoholic liver disease (ALD).

PATIENTS AND METHODS: Records of all NASH patients and 1 : 2 match with ALD transplant recipients between 2001 and 2006 were reviewed retrospectively. Patients without liver biopsies beyond 2 months following LT were excluded.

RESULTS: NASH patients (n=77) were older (P=0.0006) and less likely male (P<0.001) than ALD patients (n=108). The incidence of steatosis, NASH, and fibrosis stage increased at 1, 3, and 5 years in both groups. Although steatosis and nonalcoholic fatty liver disease activity scores were higher, fibrosis was lower in NASH compared with ALD (0.43 vs. 1.0 stage/year; P=0.0045). The incremental increase in the rate of fibrosis was faster in the first year compared with 4-5 years (0.8 vs. 0.04 stage/year) following LT. The rate of fibrosis progression during 4-5 years was decreased in NASH compared with ALD recipients (0.04 vs. 0.33 stage/year; P=0.015). NASH etiology was associated with reduced rate of fibrosis progression (odds ratio=0.67) on multivariate analysis.

CONCLUSION: Despite having more steatosis and inflammation, progression of fibrosis was slower in NASH compared with ALD recipients. Fibrosis progression slows with time following LT on immunosuppression and approximates the pretransplant progression rate by year 5.

Author List

Sourianarayanane A, Arikapudi S, McCullough AJ, Humar A

Author

Achuthan Sourianarayanane MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Biopsy
Disease Progression
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Liver
Liver Cirrhosis
Liver Diseases, Alcoholic
Liver Transplantation
Male
Middle Aged
Non-alcoholic Fatty Liver Disease
Recurrence
Retrospective Studies
Severity of Illness Index