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Incidence of Recurrent NASH-Related Allograft Cirrhosis

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Abstract

Background

Cirrhosis secondary to nonalcoholic steatohepatitis (NASH) is projected to become the leading indication for liver transplantation (LT) in the USA in the next decade. The long-term implications of post-LT NASH, specifically on the development of allograft cirrhosis, are not well known.

Methods

A retrospective cohort of patients at a single large center undergoing LT for NASH from 2000 to 2015 was identified using a prospectively collected database. A total of 226 patients undergoing LT for NASH were identified. Mean follow-up for the cohort was 7 years. Seventy-five percent of patients underwent at least one liver biopsy post-LT.

Results

Eighty-one patients (36%) developed recurrence of biopsy-proven NASH. Fifteen patients developed bridging fibrosis but only four patients (1.8%) progressed to recurrent NASH cirrhosis at a mean of 9 years post-LT. Body mass index at the time of LT was statistically higher in the NASH allograft cirrhosis group. Recurrent disease was less common and less severe in those transplanted with black donors. All four patients with recurrent NASH cirrhosis developed evidence of portal hypertension, but all remained alive at follow-up.

Conclusion

Although recurrent NASH following LT is common, the development of allograft cirrhosis is rare. These findings are useful when counseling patients and important to consider during their post-LT care.

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Abbreviations

ACR:

Acute cellular rejection

ALD:

Alcoholic liver disease

BMI:

Body mass index

CIT:

Cold ischemia time

DM:

Diabetes mellitus

HCV:

Hepatitis C virus

HTN:

Hypertension

LT:

Liver transplantation

MELD:

Model for end-stage liver disease

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

PBC:

Primary biliary cholangitis

PSC:

Primary sclerosing cholangitis

PVT:

Portal vein thrombosis

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Authors and Affiliations

  1. Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Shelly Kakar & Ricardo Cabello

  2. Center for Liver Diseases, Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, 3471 5th Ave 916 Lillian Kaufman Building, Pittsburgh, PA, USA

    Mohannad Dugum & Shahid M. Malik

  3. Division of Abdominal Transplant Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Abhinav Humar

  4. Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Jawad Ahmad

Authors
  1. Shelly Kakar
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  2. Mohannad Dugum
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  3. Ricardo Cabello
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  4. Abhinav Humar
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  5. Jawad Ahmad
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  6. Shahid M. Malik
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Contributions

SK, MD, SMM were involved in study of concept and design, acquisition of data, statistical analysis, data interpretation, drafting of the manuscript, and critical revision of the manuscript for important intellectual content. AH, RC, JA helped in data interpretation, and critical review of manuscript for important intellectual content. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Shahid M. Malik.

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The authors have no conflicts of interest to disclose.

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Kakar, S., Dugum, M., Cabello, R. et al. Incidence of Recurrent NASH-Related Allograft Cirrhosis. Dig Dis Sci 64, 1356–1363 (2019). https://doi.org/10.1007/s10620-018-5413-9

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  • DOI: https://doi.org/10.1007/s10620-018-5413-9

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