Non-alcoholic fatty liver disease in liver transplant recipients: another story of "seed and soil".
OBJECTIVE
Fatty liver disease is a potential long-term complication of liver transplantation (LT). We therefore aimed to determine the prevalence and risk factors of liver steatosis in a large population of adult post-LT patients.


METHODS
We evaluated the clinical, biological, histological, and evolutive features of patients with a diagnosis of steatosis made at liver biopsy examination during post-LT follow-up. Risk factors were analyzed by univariate and multivariate analysis.


RESULTS
In total, 1,596 liver biopsies from 599 patients were available. Recurrent liver disease was present in 178 patients. A histological diagnosis of steatosis was made in 131 (31.1%) of the remaining 421 patients (51.1% had normal liver tests): 53% had grade 1, 31% grade 2, and 16% grade 3 steatosis. Perisinusoidal fibrosis was present in 38 patients (29.0%). Histological lesions were consistent with the diagnosis of non-alcoholic steatohepatitis (NASH) in 5 patients (3.8%). At the end of follow-up, cirrhosis or extensive fibrosis was observed in 3 patients (2.25%). Multivariate analysis showed that seven factors (post-LT obesity, tacrolimus-based regimen, diabetes mellitus, hyperlipidemia, arterial hypertension, alcoholic cirrhosis as primary indication for LT, and pre-transplant liver graft steatosis) were risk factors for post-LT steatosis. When zero, one, two, three, four, five, and six factors were present, steatosis occurred in 6.0, 12.0, 22.1, 29.9, 65.5, 81.5, and 100.0%, respectively.


CONCLUSIONS
Liver steatosis is a frequent late complication of LT; its development depends on a combination of host and graft factors. LT is therefore an interesting model to study the natural history and the determinants of liver steatosis.
Dumortier
Jérôme
J
Hôpital Edouard Herriot, Unité de Transplantation Hépatique, Lyon, Cedex, France. jerome.dumortier@chu-lyon.fr
Giostra
Emiliano
E
Belbouab
Soraya
S
Morard
Isabelle
I
Guillaud
Olivier
O
Spahr
Laurent
L
Boillot
Olivier
O
Rubbia-Brandt
Laura
L
Scoazec
Jean-Yves
JY
Hadengue
Antoine
A
D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D001706:Biopsy; D016009:Chi-Square Distribution; D005234:Fatty Liver / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013557:Switzerland / Q000453:epidemiology
D007166:Immunosuppressive Agents