Incidence of Recurrent NASH-Related Allograft Cirrhosis

  • Shelly Kakar
  • Mohannad Dugum
  • Ricardo Cabello
  • Abhinav Humar
  • Jawad Ahmad
  • Shahid M. MalikEmail author
Original Article



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.


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.


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.


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.


NASH Cirrhosis Liver transplantation Allograft cirrhosis Recurrent NASH 



Acute cellular rejection


Alcoholic liver disease


Body mass index


Cold ischemia time


Diabetes mellitus


Hepatitis C virus




Liver transplantation


Model for end-stage liver disease


Nonalcoholic fatty liver disease


Nonalcoholic steatohepatitis


Primary biliary cholangitis


Primary sclerosing cholangitis


Portal vein thrombosis


Authors’ contribution

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.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Shelly Kakar
    • 1
  • Mohannad Dugum
    • 2
  • Ricardo Cabello
    • 1
  • Abhinav Humar
    • 3
  • Jawad Ahmad
    • 4
  • Shahid M. Malik
    • 2
    Email author
  1. 1.Department of MedicineUniversity of PittsburghPittsburghUSA
  2. 2.Center for Liver Diseases, Division of Gastroenterology, Hepatology and Nutrition, Department of MedicineUniversity of PittsburghPittsburghUSA
  3. 3.Division of Abdominal Transplant Surgery, Department of SurgeryUniversity of PittsburghPittsburghUSA
  4. 4.Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkUSA

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