Risk factors and clinical course for liver steatosis or nonalcoholic steatohepatitis after living donor liver transplantation

Background Posttransplant liver steatosis occurs frequently and can affect patient outcome. Our aim was to clarify the risk factors for steatosis or steatohepatitis after living donor liver transplantation (LT) through a retrospective examination of recent 100 living donor LT recipients and their liver donors. Methods Liver biopsy was performed at 1-year after LT and each year, thereafter, or as needed due to abnormal liver enzyme levels, with a median follow-up of 4 (2~10) years. Results Liver steatosis (≥5%) was identified in 33 cases, with steatohepatitis identified in 9 of 33 patients with liver steatosis. Recipients with liver steatosis were younger than those without steatosis (53.4±9.5 years versus 57.6±9.9 years, respectively; p=0.045). Of note, the prevalence of steatosis was significantly higher among LT recipients who received a graft from a donor with steatosis than without (60% versus 23%, respectively; p=0.001). Donor steatosis was also associated with steatohepatitis in recipients after LT (steatohepatitis: simple steatosis; 88%: 50%). On multivariate analysis, younger recipient age (p=0.023) and donor steatosis (p=0.005) were independent risk factors of liver steatosis after LT. Among the 33 recipients in our study group, 26 were assessed by serial liver biopsies, with 6 showing progression of the nonalcoholic fatty liver disease activity score (NAS). An increase in body weight was predictive of steatosis progression after LT (p=0.005). Conclusions Age and donor steatosis influence the risk of liver steatosis and steatohepatitis in recipients after LT. The clinical course of steatosis is relatively benign, with only 19% developing NAS and 7.6% significant fibrosis. Received 24 January 2018. Revision received 16 May 2018. Accepted 4 June 2018. Correspondence: Hisamitsu Miyaaki MD, Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Tel: +81-958-19-7481. Fax: +81-958-19-7482 Disclosure Statement of COI;The authors have no conflicts of interest Authors' contribution Hisamitsu Miyaaki; study design, statistical analysis, data interpretation, manuscript preparation, literature search Satoshi Miuma; data collection Naota taura; data collection Hidetaka shibata; data collection Ryu sasaki; data collection Akihiko Soyama; data collection Masaaki Hidaka; data collection Mitsuhisa Takatsuki; data collection Susumu Eguchi; data collection Kazuhiko Nakao; data interpretation  Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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