Incidence of Recurrent NASH-Related Allograft Cirrhosis
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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.
KeywordsNASH Cirrhosis Liver transplantation Allograft cirrhosis Recurrent NASH
Acute cellular rejection
Alcoholic liver disease
Body mass index
Cold ischemia time
Hepatitis C virus
Model for end-stage liver disease
Nonalcoholic fatty liver disease
Primary biliary cholangitis
Primary sclerosing cholangitis
Portal vein thrombosis
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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