title: Nonalcoholic steatohepatitis recurrence and rate of fibrosis progression following liver transplantation.
abstract: BACKGROUND
  Nonalcoholic steatohepatitis (NASH) is known to recur following liver transplantation (LT). Metabolic risk factors increase with immunosuppression. However, the rate of fibrosis progression following LT for NASH while on immunosuppression is less clear.
  
  
  OBJECTIVE
  The incidences of steatosis, NASH, and fibrosis following LT for NASH were quantified and compared with those transplanted for alcoholic liver disease (ALD).
  
  
  METHODS
  Records of all NASH patients and 1 : 2 match with ALD transplant recipients between 2001 and 2006 were reviewed retrospectively. Patients without liver biopsies beyond 2 months following LT were excluded.
  
  
  RESULTS
  NASH patients (n=77) were older (P=0.0006) and less likely male (P<0.001) than ALD patients (n=108). The incidence of steatosis, NASH, and fibrosis stage increased at 1, 3, and 5 years in both groups. Although steatosis and nonalcoholic fatty liver disease activity scores were higher, fibrosis was lower in NASH compared with ALD (0.43 vs. 1.0 stage/year; P=0.0045). The incremental increase in the rate of fibrosis was faster in the first year compared with 4-5 years (0.8 vs. 0.04 stage/year) following LT. The rate of fibrosis progression during 4-5 years was decreased in NASH compared with ALD recipients (0.04 vs. 0.33 stage/year; P=0.015). NASH etiology was associated with reduced rate of fibrosis progression (odds ratio=0.67) on multivariate analysis.
  
  
  CONCLUSIONS
  Despite having more steatosis and inflammation, progression of fibrosis was slower in NASH compared with ALD recipients. Fibrosis progression slows with time following LT on immunosuppression and approximates the pretransplant progression rate by year 5.
authors.affiliation: Departments of aGastroenterology, Hepatology and NutritionbTransplant Surgery, University of Pittsburgh, Pittsburgh, PennsylvaniacDepartment of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WisconsindDepartment of Gastroenterology & Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Achuthan
authors.initials: A
authors.lastname: Sourianarayanane
authors.forename: Sowminya
authors.initials: S
authors.lastname: Arikapudi
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: McCullough
authors.forename: Abhinav
authors.initials: A
authors.lastname: Humar
mesh_terms: D000368:Aged; D001706:Biopsy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000209:etiology* / Q000473:pathology; D008108:Liver Diseases, Alcoholic / Q000150:complications / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index