NAFLD Recurrence in Liver Transplant Recipients

Background and Aims. Nonalcoholic fatty liver disease (NAFLD) is a common indication for liver transplantation and can recur in the graft. To describe this recurrence, we performed a cohort study of individuals undergoing liver transplantation for NAFLD-related cirrhosis between 1993 and 2007. Predictors of NAFLD recurrence and outcomes in this cohort were also studied. Methods. Eighty-eight liver transplant recipients were included in this study. NAFLD recurrence was described by performing a blinded reevaluation of posttransplant liver biopsies and classified according to histologic activity (NAFLD activity score) and fibrosis. Results. Recurrent NAFLD was seen in 34 (39%) recipients with isolated steatosis in 9 and steatohepatitis in 25 recipients. Severe recurrence was seen in 3 of 34 recipients (NAFLD activity score >= 5) and advanced fibrosis in 3 recipients. NAFLD recurrence correlated with higher pretransplant (P = 0.001) and posttransplant body mass index (P < 0.0001) and increased triglyceride levels posttransplantation. Serum triglyceride levels at 6 and 12 months were 280 +/- 129 and 324 +/- 265 mg/dL, respectively, in those with NAFLD recurrence versus 206 +/- 96 mg/dL at 6 months and 190 +/- 103 mg/dL in those without NAFLD recurrence (P = 0.007 at 6 months and P = 0.005 at 12 months). Average steroid dose at 6 months posttransplant was also higher in those with NALFD recurrence than those without (11 +/- 8.5 and 7.2 +/- 5.7 mg/day, P = 0.04). Posttransplant survival did not differ between those with and without NAFLD recurrence during the entire follow-up period (P = 0.78). Posttransplant cardiovascular disease was significantly and adversely correlated with posttransplant survival. Conclusions. NAFLD recurrence is common in the first 5 years postliver transplantation and is associated with features of the metabolic syndrome. Although NAFLD recurrence was not associated with higher mortality in our cohort, cardiovascular mortality and morbidity were common, suggesting that the metabolic syndrome is an important link to NAFLD recurrence and cardiovascular deaths posttransplantation.