Predictors of de novo nonalcoholic fatty liver disease after liver transplantation and associated fibrosis
Abstract
Nonalcoholic fatty liver disease (NAFLD) can occur de novo in patients undergoing liver transplantation (LT) for indications other than NAFLD, and it has been increasingly recognized as a complication in the post-LT setting. This study aims to better characterize de novo NAFLD after LT by identifying risk factors for its development, describing incidence and extent of fibrosis, assessing the diagnostic utility of noninvasive serum fibrosis algorithms, and comparing survival to those without NAFLD. This was a retrospective single-center analysis of de novo NAFLD in a post-LT cohort. Those whose primary indication for LT was nonalcoholic steatohepatitis (NASH) were excluded. Risk factors were analyzed by univariate and multivariate analyses. De novo NAFLD and fibrosis were assessed on posttransplant liver biopsies, and noninvasive fibrosis scores were calculated from concomitant blood tests. After applying the exclusion criteria, 430 for-cause post-LT biopsies were evaluated; 33.3% (n = 143) had evidence of de novo steatosis and/or NASH at a median of 3.0 years after transplant. On multivariate analysis, body mass index (BMI; odds ratio [OR], 1.12; P < 0.001), diabetes mellitus (OR, 3.01; P = 0.002), hepatitis C virus (OR, 4.61; P < 0.001), weight gain (OR, 1.03; P = 0.007), and sirolimus use (OR, 3.11; P = 0.02) were predictive of de novo NAFLD after LT. Significant fibrosis (≥F2) was present in almost 40% of the cohort. Noninvasive serum fibrosis scores were not useful diagnostic tests. There was no significant difference in the short-term or longterm survival of patients who developed de novo NAFLD. In conclusion, diabetes, BMI, weight gain after LT, and sirolimus-based immunosuppression, in keeping with insulin resistance, were the only modifiable factors associated with development of de novo NAFLD. A significant proportion of patients with de novo NAFLD had fibrosis and given the limited utility of noninvasive serum fibrosis algorithms, alternative noninvasive tools are required to screen for fibrosis in this population. There was no significant difference in the short-term or longterm survival of patients who developed de novo NAFLD.
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The largest study with long follow-up documented advanced fibrosis/cirrhosis in 20% of cases 3 years after liver transplantation.
“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 [517]
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Self-citation
- Authors
- Galvin, Z., Rajakumar, R., Chen, E., Adeyi, O., Selzner, M., Grant, D., Sapisochin, G., Greig, P., Cattral, M., McGilvray, I., Ghanekar, A., Selzner, N., Lilly, L., Patel, K., & Bhat, M.
- Affiliations
- Multi‐Organ Transplant Program
- University Health Network (CA)
- Corresponding author
- Galvin, Zita
- ORCID
- Venue
- Liver Transplantation
- Published
- 2019-01
- Volume
- 25
- Issue
- 1
- Pages
- 56-67
- ISSN
- 1527-6465 (ISSN-L)
- 1527-6473
- OpenAlex
- W2908318651
- Cited by
- 76
- References
- 47
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 12 · 2023: 16 · 2022: 11 · 2021: 11 · 2020: 10 · 2019: 3
- FWCI
- 6.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- 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 Disease and Transplantation
- Keywords
- liver fibrosis, risk factors, body mass index, diabetes mellitus, hepatitis C virus, weight gain, rapamycin, immunosuppression, non-invasive fibrosis scores, insulin resistance, survival outcomes
- MeSH terms
- Adult, Female, Humans, Liver, Liver Cirrhosis, Male, Middle Aged, Postoperative Complications, Prognosis, Retrospective Studies, Risk Factors, Incidence, Survival Analysis, Liver Transplantation, Disease Progression, End Stage Liver Disease, Allografts, Non-alcoholic Fatty Liver Disease
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