title: Noninvasive characterization of graft steatosis after liver transplantation.
abstract: OBJECTIVE
  Liver graft steatosis has not been noninvasively evaluated yet. We therefore characterized liver transplant recipients by transient elastography (TE) and controlled attenuation parameter (CAP) and correlated the results with clinical and genetic risk factors.
  
  
  METHODS
  A total of 204 patients (pretransplant disease: n = 102 nonalcoholic etiology, nonalcoholic liver cirrhosis (non-ALC); n = 102 alcoholic liver disease, ALC; 42% female; median age 57.8 years; median time since transplantation 66 months) underwent ultrasound, TE, CAP, and nonalcoholic fatty liver disease (NAFLD) fibrosis score. Recipient DNA samples were genotyped for patatin-like phospholipase domain-containing protein 3 (PNPLA3) (rs738409) and IL28B (rs8099917, rs12979860) polymorphisms.
  
  
  RESULTS
  Increased hepatic echogenicity at ultrasound was observed in 36% of patients, CAP values >252 and >300 dB/m indicated steatosis and advanced steatosis in 44% and 24% of individuals. Advanced fibrosis (TE >7.9 kPa) was associated with increased CAP results (266 vs. 229 dB/m, p = 0.012). PNPLA3 G-allele carriers had increased CAP values (257 vs. 222 dB/m, p = 0.032), higher liver stiffness (TE 6.4 vs. 5.5 kPa, p = 0.005), and prevalence of diabetes mellitus (40% vs. 22%, p = 0.016). No such association was observed for IL28B polymorphisms. ALC compared to non-ALC patients had higher body mass index (28.1 vs. 25.5 kg/m², p < 0.001), higher prevalence of diabetes mellitus (41% vs. 25%, p = 0.017), and PNPLA3 CG + GG genotype (73% vs. 47%, p = 0.006), and had elevated TE (6.3 vs. 5.4 kPa, p = 0.022), CAP (266 vs. 221 dB/m, p = 0.001), and NAFLD fibrosis score (score -0.5 vs. -1.3, p < 0.001).
  
  
  CONCLUSIONS
  Modern noninvasive liver graft assessment frequently detects hepatic steatosis, which is associated with graft fibrosis, components of the metabolic syndrome and recipient PNPLA3 rs738409 genotype, especially in ALC patients.
authors.affiliation: Leipzig University Medical Center, IFB Adiposity Diseases , Leipzig , Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Karlas
authors.forename: Johanna
authors.initials: J
authors.lastname: Kollmeier
authors.forename: Stephan
authors.initials: S
authors.lastname: Böhm
authors.forename: Jürgen
authors.initials: J
authors.lastname: Müller
authors.forename: Peter
authors.initials: P
authors.lastname: Kovacs
authors.forename: Michael
authors.initials: M
authors.lastname: Tröltzsch
authors.forename: Antje
authors.initials: A
authors.lastname: Weimann
authors.forename: Michael
authors.initials: M
authors.lastname: Bartels
authors.forename: Jonas
authors.initials: J
authors.lastname: Rosendahl
authors.forename: Joachim
authors.initials: J
authors.lastname: Mössner
authors.forename: Thomas
authors.initials: T
authors.lastname: Berg
authors.forename: Volker
authors.initials: V
authors.lastname: Keim
authors.forename: Johannes
authors.initials: J
authors.lastname: Wiegand
mesh_terms: D000328:Adult; D000368:Aged; D000483:Alleles; D015992:Body Mass Index; D015331:Cohort Studies; D003920:Diabetes Mellitus; D054459:Elasticity Imaging Techniques; D005260:Female; D005838:Genotype; D006801:Humans; D007372:Interferons; D007378:Interleukins / Q000235:genetics*; D008049:Lipase / Q000235:genetics*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008565:Membrane Proteins / Q000235:genetics*; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000235:genetics*; D020641:Polymorphism, Single Nucleotide; D012307:Risk Factors; D055815:Young Adult; D000095022:Interferon Lambda; D000217:Acyltransferases; D054512:Phospholipases A2, Calcium-Independent
chemical_list: D007372:Interferons; D007378:Interleukins; D008049:Lipase; D008565:Membrane Proteins; C000624353:interferon-lambda, human; D000095022:Interferon Lambda; C533682:PNPLA3 protein, human; D000217:Acyltransferases; D054512:Phospholipases A2, Calcium-Independent
keywords: NAFLD fibrosis score; controlled attenuation parameter; elastography; liver stiffness; steatosis