Lipoatrophic diabetes and end-stage liver disease secondary to nonalcoholic steatohepatitis with recurrence after liver transplantation

Background, Lipoatrophic diabetes is an insulin resistance syndrome charact erized by the complete or partial lack of adipose tissue and disturbances i n lipid and glucose metabolism. Nonalcoholic steatohepatitis (NASH) is a we ll-described change in liver pathology consisting of steatosis, hepatitis, and fibrosis that can be associated with lipoatrophic diabetes. Results. This article describes the first reported case of lipoatrophic dia betes with NASH leading to liver failure and liver transplantation. Before transplantation, the patient required 600-700 U of insulin/day. After trans plantation, a dramatic decline in her insulin requirements was observed, de spite corticosteroids, Eighteen months after transplantation, her glycemic control worsened, and she developed recurrent NASH on serial liver biopsies . Conclusions. NASH associated with lipoatrophic diabetes can recur after liv er transplantation, and in this case, was accompanied by increased insulin requirements. These results suggest that the development of NASH itself may contribute to the insulin resistance observed in lipoatrophic diabetes.