title: De novo non-alcoholic fatty liver disease following orthotopic liver transplantation.
abstract: Non-alcoholic fatty liver disease (NAFLD) is an increasingly recognized clinico-pathologic entity typically associated with obesity, type II diabetes and hyperlipidemia. It has been noted to recur after orthotopic liver transplantation (OLT). We report four patients who developed de novo NAFLD within 3 months of OLT without the typical predisposing factors of diabetes mellitus or obesity. Three of the four patients underwent OLT for hepatitis C-related cirrhosis, and the other for alcoholic cirrhosis. Examination of the liver explants revealed no evidence of steatosis. No surreptitious alcohol use or a drug-induced process could be identified in these patients. Treatment of recurrent hepatitis C infection in one patient with interferon and ribavirin led to sustained suppression of the viral RNA to undetectable levels, but no improvement in histology or liver enzymes. All four patients had histologic evidence of preservation injury on the initial post-OLT biopsies, but the significance of this finding in relationship to the development of NAFLD is unknown. NAFLD can develop without any of the known predisposing conditions after transplantation, and this raises further questions about the pathogenesis of this condition.
authors.affiliation: Department of Transplantation, California Pacific Medical Center, San Francisco, USA. fred.poordad@cshs.org
authors.forename: Fred
authors.initials: F
authors.lastname: Poordad
authors.forename: Robert
authors.initials: R
authors.lastname: Gish
authors.forename: Adil
authors.initials: A
authors.lastname: Wakil
authors.forename: Richard
authors.initials: R
authors.lastname: Garcia-Kennedy
authors.forename: Paul
authors.initials: P
authors.lastname: Martin
authors.forename: Francis Y
authors.initials: FY
authors.lastname: Yao
mesh_terms: D000328:Adult; D005234:Fatty Liver / Q000150:complications / Q000209:etiology*; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000628:therapy; D008107:Liver Diseases / Q000150:complications / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012367:RNA, Viral / Q000378:metabolism; D012307:Risk Factors; D013997:Time Factors
chemical_list: D012367:RNA, Viral