Cryptogenic cirrhosis and posttransplantation nonalcoholic fatty liver disease

Some patients diagnosed with cryptogenic cirrhosis may have "burned-out" no nalcoholic fatty liver disease (NAFL). To test this hypothesis, we used our liver transplant database (November 1984 to November 1998) to assess the i ncidence of NAFL in patients with cryptogenic cirrhosis after orthotopic li ver transplantation (OLT). We also examined the clinicodemographic features associated with post-OLT NAFL, obtained by chart review and telephone inte rviews. When available, post-OLT liver biopsy specimens were reviewed blind ly by a hepatopathologist according to the NAFL pathology protocol. We iden tified 51 patients with cryptogenic cirrhosis (mean age, 51 +/- 12 years); 60% were women, 94% were white, and 34% had type 2 diabetes mellitus (DM). Mean pre-OLT body mass index (BMI) was 27.33 +/- 5.54 kg/m(2). Twenty-five patients underwent at least 1 post-OLT liver biopsy. Post-OLT NAFL was iden tified in 13 patients (25.4%), whereas post-OLT nonalcoholic steatohepatiti s (NASH) was seen in 8 patients (15.7%). Features associated with post-OLT NASH were pre- and post-OLT type 2 DM (P less than or equal to .05) and an elevated fasting triglyceride level (P < .05). BMI tended to be greater in patients with post-OLT NAFL or NASH. Those who did not develop post-OLT NAF L showed a decrease in BMI. Patients with cryptogenic cirrhosis undergoing OLT resemble patients with NAFL. Post-OLT NAFL and NASH can be seen in a nu mber of patients with cryptogenic cirrhosis. This supports the notion that some cases of cryptogenic cirrhosis represent burned-out NAFL.