Frequency of nonalcoholic steatohepatitis as a cause of advanced liver disease

Although nonalcoholic steatohepatitis (NASH) has generally been considered a benign condition, the increasing prevalence and severity of obesity has h eightened concerns about the frequency with which NASH progresses to end-st age liver disease. The aim of this study is to determine the frequency clin ical features, and posttransplantation history of decompensated liver disea se secondary to NASH. The frequency of NASH as a cause of end-stage liver d isease was prospectively determined in patients evaluated for liver transpl antation. NASH was considered to be the primary cause of liver disease in p atients who had histological evidence of steatohepatitis and in whom chroni c liver diseases other than NASH were excluded. Posttransplantation histolo gical characteristics were also determined in patients with NASH and compar ed with those of patients with pretransplantation diagnoses of cholestatic liver diseases, alcoholic disease, and hepatitis C. Of 1,207 patients evalu ated for liver transplantation during the study period, 31 patients (2.6%) had NASH as the primary cause of liver disease. In the same period, 546 liv er transplantations were performed, 16 of which (2.9%) were for end-stage d isease secondary to NASH. Posttransplantation steatosis was seen in 60% of transplant recipients with NASH versus 5% of those with cholestatic disease ,; 15% of those with alcoholic disease, and 15% of those with hepatitis C. Steatohepatitis recurred in 33% of transplant recipients with NASH, with pr ogression to cirrhosis in 12.5%. NASH can progress to end-stage liver disea se in a minority of affected patients and was the primary cause of liver di sease in 2.9% of patients evaluated for Liver transplantation at oar center , Recurrence of steatosis and NASH is frequent and can be severe after live r transplantation.