Recurrent or de novo nonalcoholic fatty liver disease after liver transplantation: natural history based on liver biopsy analysis
Open accessAbstract
Nonalcoholic fatty liver disease (NAFLD) is a potential long-term complication after liver transplantation (LT) and can occur as recurrent disease in patients undergoing transplantation for NAFLD or as de novo NAFLD in others. The aim of this study was to compare these 2 different entities. From a cohort of adult patients undergoing transplantation between 2000 and 2010, we selected all patients with a diagnosis of NAFLD made during liver biopsy examinations during post-LT follow-up; clinical, biological, and histological features of patients with recurrent NAFLD and patients with de novo NAFLD were compared. The diagnosis of post-LT NAFLD was made for 91 patients during the study period: 11 cases were classified as recurrent NAFLD, and 80 cases were classified as de novo NAFLD. The groups were not statistically different with respect to the sex ratio, age, prevalence of hypercholesterolemia, prevalence of obesity, or prevalence of hypertension. The prevalence of diabetes mellitus was higher in patients with recurrent NAFLD (100% versus 37.5%, p < 0.01). At 5 years, severe fibrosis (stage 3 or 4) and steatohepatitis were more frequent in patients with recurrent NAFLD versus patients with de novo NAFLD [71.4% versus 12.5% (P < 0.01) and 71.4% versus 17.2% (P < 0.01), respectively]. NAFLD was already present in 67% of the patients with de novo NAFLD and in 100% of the patients with recurrent NAFLD after 1 year. According to successive liver biopsies, steatosis disappeared in 18 patients (22.5%) with de novo NAFLD and in none of the patients with recurrent NAFLD. In conclusion, our results strongly suggest that recurrent NAFLD and de novo NAFLD after LT are different entities; recurrent NAFLD appears to be a more severe and irreversible disease with an earlier onset.
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In a multicentric retrospective study of 150 individuals specifically transplanted for MASLD-related cirrhosis, 5-year recurrence rates for metabolic syndrome, steatosis, steatohepatitis and advanced fibrosis (stages 3 and 4) were 86%, 80%, 60% and 20%, respectively.
“In a multicentric retrospective study of 150 individuals speci fi cally transplanted for MASLD-related cirrhosis, 5-year recurrence rates for metabolic syndrome, steatosis, steatohepatitis and advanced fi brosis (stages 3 and 4) were 86%, 80%, 60% and 20%, respectively. 515”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [515]
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Experimental — accuracy not yet measuredSome studies reported that de novo MASH may be less severe histologically and less durable than recurrent MASH.
“While some studies reported that de novo MASHmaybelessseverehistologically (advanced fi brosis, steatohepatitis) and less durable than recurrent MASH, 515 the largest study with long follow-up documented advanced fi brosis/cirrhosis in 20% of cases 3 years after liver transplantation. 517”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [515]
The Histological Features of NAFLD section reports less severe fibrosis and less frequent steatohepatitis in de novo than recurrent disease at one and five years after transplantation. The Abstract also reports that steatosis disappeared in 22.5% of de novo NAFLD cases but in no recurrent cases. That supports lower persistence of de novo NAFLD, but the paper does not specifically establish that de novo MASH (steatohepatitis) is less durable. (LLM, conf=0.86)
Experimental — accuracy not yet measuredDescriptive data on de novo MASH is scarce and conflicting, with a blurry distinction from recurrent MASLD due to imprecise adjudication of MASLD as a primary cause of transplant.
“Descriptive data on de novo MASH ( i.e. steatohepatitis occurring in liver transplant recipients transplanted for diseases other than MASLD) is even more scarce and con fl icting, 515,516 with a blurry distinction from recurrent MASLD due to imprecise adjudication of MASLD as a primary cause of transplant.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [515]
The Discussion reports differing rates of de novo steatohepatitis across studies, and the paper says that long-term histological data after transplantation are limited. The Inclusion Criteria define de novo and recurrent disease by the reason for transplantation, but the paper does not attribute a blurry distinction between them to imprecise adjudication of NAFLD as the primary transplant indication. Page numbers are unavailable in our copy. (LLM, conf=0.84)
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- Authors
- Vallin, M., Guillaud, O., Boillot, O., Hervieu, V., Scoazec, J.-Y., & Dumortier, J.
- Affiliations
- Hospices Civils de Lyon (FR)
- Lyon 1 Université (FR)
- Corresponding author
- Dumortier, Jérôme
- Venue
- Liver Transplantation
- Published
- 2014-09
- Volume
- 20
- Issue
- 9
- Pages
- 1064-1071
- ISSN
- 1527-6465 (ISSN-L)
- OpenAlex
- W2104099377
- Cited by
- 137
- References
- 25
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 13 · 2023: 20 · 2022: 12 · 2021: 14 · 2020: 16 · 2019: 9 · 2018: 16 · 2017: 10 · 2016: 10 · 2015: 4
- FWCI
- 6.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Liver Transplantation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Hepatology › Liver physiology and pathology
- Keywords
- non-alcoholic fatty liver disease, post-transplant complications, liver fibrosis, steatohepatitis, steatosis, diabetes mellitus, histological features, natural history (disease)
- MeSH terms
- Aged, Biopsy, Female, France, Humans, Male, Middle Aged, Predictive Value of Tests, Recurrence, Risk Factors, Time Factors, Comorbidity, Prevalence, Liver Transplantation, Treatment Outcome, Non-alcoholic Fatty Liver Disease
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