Clinicopathologic features of de novo non-alcoholic steatohepatitis in the post-transplant setting
Open accessAbstract
BACKGROUND: Non-alcoholic steatohepatitis (NASH) has become an increasingly recognized problem in patients after orthotopic liver transplant. The aims of this study were to compare the clinicopathologic features of recurrent and de novo NASH. METHODS: From 1995 to 2016, we performed a retrospective review of patients with a histological diagnosis of non-alcoholic steatohepatitis made more than 6 months after liver transplant at University of California, San Francisco. The cases were categorized into de novo (n = 19) or recurrent steatohepatitis (n = 37). RESULTS: Hepatitis C virus (HCV) infection-related cirrhosis was the most common etiology of transplantation in de novo NASH (78% of cases, n = 29). There was no difference in glycogenosis or presence of grade 3 steatosis. More recurrent NASH biopsies had small ballooned hepatocytes (62.5% of cases) compared to de novo NASH (26.7%) (p = 0.03), and were less likely to show prominent portal inflammation (5% versus 40.5%, p = 0.0049). The diagnosis of recurrent NASH was made significantly sooner after transplantation than the diagnosis of de novo NASH (2.8 years versus 4.8 years, p = 0.02). CONCLUSIONS: Overall, our results support that recurrent NASH demonstrates distinct clinicopathologic features compared to de novo NASH arising in the post-transplant setting.
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Descriptive 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 [516]
The Discussion (page unavailable) contrasts this study’s fibrosis findings with a prior study and calls for further research, supporting the characterization of the evidence as limited and conflicting. Methods > Patient selection (page unavailable) defines de novo and recurrent NASH using transplant indications and metabolic comorbidities; it does not say that imprecise adjudication of the primary transplant cause blurs the distinction. (LLM, conf=0.78)
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- Authors
- Balitzer, D., Tsai, J.-H., & Gill, R. M.
- Affiliations
- San Francisco VA Medical Center (US)
- National Taiwan University (TW)
- University of California, San Francisco (US)
- Corresponding author
- Balitzer, Dana
- Venue
- Diagnostic Pathology
- Published
- 2022-08-10
- Volume
- 17
- Issue
- 1
- Pages
- 65-65
- ISSN
- 1746-1596 (ISSN-L)
- PMC
- PMC9367095
- OpenAlex
- W4291020434
- Cited by
- 5
- References
- 36
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 1
- FWCI
- 0.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Diagnostic Pathology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Funders
- University of California, San Francisco
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Keywords
- nonalcoholic steatohepatitis, liver transplantation, post-transplant liver disease, hepatitis C cirrhosis, steatosis, ballooning degeneration, portal inflammation, histopathology
- MeSH terms
- Humans, Liver Cirrhosis, Retrospective Studies, Risk Factors, Liver Transplantation, Non-alcoholic Fatty Liver Disease
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