title: Non-alcoholic fatty liver disease in liver transplant recipients: another story of "seed and soil".
abstract: 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.
authors.affiliation: Hôpital Edouard Herriot, Unité de Transplantation Hépatique, Lyon, Cedex, France. jerome.dumortier@chu-lyon.fr
authors.forename: Jérôme
authors.initials: J
authors.lastname: Dumortier
authors.forename: Emiliano
authors.initials: E
authors.lastname: Giostra
authors.forename: Soraya
authors.initials: S
authors.lastname: Belbouab
authors.forename: Isabelle
authors.initials: I
authors.lastname: Morard
authors.forename: Olivier
authors.initials: O
authors.lastname: Guillaud
authors.forename: Laurent
authors.initials: L
authors.lastname: Spahr
authors.forename: Olivier
authors.initials: O
authors.lastname: Boillot
authors.forename: Laura
authors.initials: L
authors.lastname: Rubbia-Brandt
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Scoazec
authors.forename: Antoine
authors.initials: A
authors.lastname: Hadengue
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents