title: Long-term Outcomes in Patients Undergoing Liver Transplantation for Nonalcoholic Steatohepatitis-Related Cirrhosis.
abstract: Nonalcoholic steatohepatitis (NASH), a clinically aggressive variant of nonalcoholic fatty liver disease (NAFLD), is becoming an increasingly common indication for liver transplantation (LT); however, relatively little is known regarding its clinical course post-LT. The aim of the current study is to describe disease recurrence and clinical course after LT.
  
  
  
  All surviving patients transplanted for NASH at the authors' institution had transient elastography (TE) to evaluate hepatic steatosis and fibrosis. The charts of deceased patients were reviewed for liver biopsy to evaluate for disease recurrence. Finally, causes of mortality in these patients were evaluated.
  
  
  
  Of the 103 patients who met criteria, 56 had TE, whereas 34 had a liver biopsy. Steatosis was detected in 49 (87.5%) of the patients who had a TE and were defined to have recurrent NAFLD. Most patients had liver stiffness measurements consistent with no fibrosis (42.9%) or F1-F2 fibrosis (30.4%). Advanced fibrosis was noted in 26.8%, whereas 5.4% had cirrhosis but were clinically compensated. In patients with liver biopsy, 88.2% had recurrent NAFLD, whereas 41.2% had recurrent NASH. Bridging fibrosis was noted in 20.6% of patients but no patients had cirrhosis. Within the cohort, 32 patients died with the leading cause of mortality cancer (25%), infectious complications (25%), and cardiovascular disease (21.9%). Only 9% of deaths were attributable to graft cirrhosis.
  
  
  
  Recurrent NAFLD is common post-LT occurring in nearly 88% of all patients, whereas nearly a quarter of patients were noted to have advanced fibrosis.
authors.affiliation: 1 Division of Transplant Surgery, Virginia Commonwealth University, Richmond, VA. 2 Department of Pathology, Virginia Commonwealth University, Richmond, VA. 3 Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, VA. 4 Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, VA.
authors.forename: Chandra
authors.initials: C
authors.lastname: Bhati
authors.forename: Michael O
authors.initials: MO
authors.lastname: Idowu
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Sanyal
authors.forename: Maria
authors.initials: M
authors.lastname: Rivera
authors.forename: Carolyn
authors.initials: C
authors.lastname: Driscoll
authors.forename: Richard T
authors.initials: RT
authors.lastname: Stravitz
authors.forename: Divyanshoo R
authors.initials: DR
authors.lastname: Kohli
authors.forename: Scott
authors.initials: S
authors.lastname: Matherly
authors.forename: Puneet
authors.initials: P
authors.lastname: Puri
authors.forename: HoChong
authors.initials: H
authors.lastname: Gilles
authors.forename: Adrian
authors.initials: A
authors.lastname: Cotterell
authors.forename: Marlon
authors.initials: M
authors.lastname: Levy
authors.forename: Richard K
authors.initials: RK
authors.lastname: Sterling
authors.forename: Velimir A
authors.initials: VA
authors.lastname: Luketic
authors.forename: Hannah
authors.initials: H
authors.lastname: Lee
authors.forename: Amit
authors.initials: A
authors.lastname: Sharma
authors.forename: Mohammad Shadab
authors.initials: MS
authors.lastname: Siddiqui
mesh_terms: D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome