Development of nonalcoholic fatty liver disease after orthotopic liver transplantation for cryptogenic cirrhosis

Many subjects with cryptogenic cirrhosis have underlying nonalcoholic steat ohepatitis (NASH), The natural history of NASH-related cryptogenic cirrhosi s after orthotopic liver transplantation (OLT) is not well defined. A prima rily retrospective study of patients with the clinical histological phenoty pe of NASH-related cirrhosis undergoing OLT was performed. Data were compar ed with 2 sets of age- and weight-matched controls with (1) primary biliary cirrhosis or primary sclerosing cholangitis or (2) alcoholic liver disease . After OLT, all patients were managed by a standard immunosuppressive prot ocol. Liver biopsies were performed at 6 and 12 months after OLT and at 1- to 2-year intervals thereafter, as well as when liver enzyme levels were el evated enough to warrant diagnostic biopsy. Twenty-seven subjects with cryp togenic cirrhosis and a clinical histological phenotype of NASH and 3 patie nts with a long-standing diagnosis of NASH before OLT were included. The 30 -day perioperative mortality was 1 in 30 patients, During a median follow-u p of 3.5 +/- 2.7 years, 2 additional patients died of sepsis, There was a t ime-dependent increase in the risk for allograft steatosis that approached 100% by 5 years compared with only an approximately 25% incidence of steato sis in the control groups (P < .009, log-rank test). On multivariate analys is, only the cumulative steroid dose correlated with time to development of allograft steatosis, Three patients developed histological progression fro m hepatic steatosis to steatohepatitis, Of these, 1 patient developed progr essive fibrosis. Four patients experienced at least 1 episode of acute cell ular rejection; however, no patient developed chronic rejection or graft fa ilure. In conclusion, nonalcoholic fatty liver disease occurs frequently af ter OLT in patients with the phenotype of NASH-related cirrhosis. Despite t he frequent histological recurrence of disease, clinical outcomes are simil ar to those of other groups of patients undergoing OLT.