%0 Journal Article
%T Inevitability of disease recurrence after liver transplantation for NAFLD cirrhosis.
%A Villeret F
%A Dharancy S
%A Erard D
%A Abergel A
%A Barbier L
%A Besch C
%A Boillot O
%A Boudjema K
%A Coilly A
%A Conti F
%A Corpechot C
%A Duvoux C
%A Faitot F
%A Faure S
%A Francoz C
%A Giostra E
%A Gugenheim J
%A Hardwigsen J
%A Hilleret MN
%A Hiriart JB
%A Houssel-Debry P
%A Kamar N
%A Lassailly G
%A Latournerie M
%A Pageaux GP
%A Samuel D
%A Vanlemmens C
%A Saliba F
%A Dumortier J
%J JHEP Rep
%V 5
%N 3
%D Mar 2023
%M 36852108
%F 9.917
%R 10.1016/j.jhepr.2022.100668
%X UNASSIGNED: Liver transplantation (LT) is the only available treatment for end-stage non-alcoholic fatty liver disease (NAFLD) (related decompensated cirrhosis and/or hepatocellular carcinoma). The aim of our study was to evaluate the risk of disease recurrence after LT and the factors influencing it.
UNASSIGNED: This retrospective multicenter study included adults transplanted for NAFLD cirrhosis between 2000 and 2019 in 20 participating French-speaking centers. Disease recurrence (steatosis, steatohepatitis and fibrosis) was diagnosed from liver graft biopsies.
UNASSIGNED: We analyzed 150 patients with at least one graft liver biopsy available ≥6 months after transplantation, among 361 patients transplanted for NAFLD. The median (IQR) age at LT was 61.3 (54.4-64.6) years. The median follow-up after LT was 4.7 (2.8-8.1) years. The cumulative recurrence rates of steatosis and steatohepatitis at 5 years were 80.0% and 60.3%, respectively. Significant risk factors for steatohepatitis recurrence in multivariate analysis were recipient age at LT <65 years (odds ratio [OR] 4.214; p = 0.044), high-density lipoprotein-cholesterol <1.15 mmol/L after LT (OR 3.463; p = 0.013) and grade ≥2 steatosis on the graft at 1 year after LT (OR 10.196; p = 0.001). The cumulative incidence of advanced fibrosis (F3-F4) was 20.0% at 5 years after LT and significant risk factors from multivariate analysis were metabolic syndrome before LT (OR 8.550; p = 0.038), long-term use of cyclosporine (OR 11.388; p = 0.031) and grade ≥2 steatosis at 1 year after LT (OR 10.720; p = 0.049). No re-LT was performed for NAFLD cirrhosis recurrence.
UNASSIGNED: Our results strongly suggest that recurrence of initial disease after LT for NAFLD is inevitable and progressive in a large proportion of patients; the means to prevent it remain to be further evaluated.
UNASSIGNED: Non-alcoholic fatty liver disease (NAFLD) is a growing indication for liver transplantation, but the analysis of disease recurrence, based on graft liver biopsies, has been poorly studied. Cumulative incidences of steatosis, steatohepatitis and NAFLD-related significant fibrosis recurrence at 5 years were 85.0%, 60.3% and 48.0%, respectively. Grade ≥2 steatosis on graft biopsy at 1 year (present in 25% of patients) is highly predictive of recurrence of steatohepatitis and advanced fibrosis: bariatric surgery should be discussed in these patients specifically.