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Development of nonalcoholic fatty liver disease after orthotopic liver transplantation for cryptogenic cirrhosis.
Liver Transpl. 2001 Apr; 7(4):363-73.LT

Abstract

Many subjects with cryptogenic cirrhosis have underlying nonalcoholic steatohepatitis (NASH). The natural history of NASH-related cryptogenic cirrhosis after orthotopic liver transplantation (OLT) is not well defined. A primarily retrospective study of patients with the clinical histological phenotype of NASH-related cirrhosis undergoing OLT was performed. Data were compared 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 protocol. 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 elevated enough to warrant diagnostic biopsy. Twenty-seven subjects with cryptogenic cirrhosis and a clinical histological phenotype of NASH and 3 patients 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-up of 3.5 +/- 2.7 years, 2 additional patients died of sepsis. There was a time-dependent increase in the risk for allograft steatosis that approached 100% by 5 years compared with only an approximately 25% incidence of steatosis in the control groups (P <.009, log-rank test). On multivariate analysis, only the cumulative steroid dose correlated with time to development of allograft steatosis. Three patients developed histological progression from hepatic steatosis to steatohepatitis. Of these, 1 patient developed progressive fibrosis. Four patients experienced at least 1 episode of acute cellular rejection; however, no patient developed chronic rejection or graft failure. In conclusion, nonalcoholic fatty liver disease occurs frequently after OLT in patients with the phenotype of NASH-related cirrhosis. Despite the frequent histological recurrence of disease, clinical outcomes are similar to those of other groups of patients undergoing OLT.

Authors+Show Affiliations

Department of Pathology, Division of Gastroenterology/Hepatology/Nutrition, Virginia Commonwealth University-Medical College of Virginia, Richmond, VA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

11303298

Citation

Contos, M J., et al. "Development of Nonalcoholic Fatty Liver Disease After Orthotopic Liver Transplantation for Cryptogenic Cirrhosis." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 7, no. 4, 2001, pp. 363-73.
Contos MJ, Cales W, Sterling RK, et al. Development of nonalcoholic fatty liver disease after orthotopic liver transplantation for cryptogenic cirrhosis. Liver Transpl. 2001;7(4):363-73.
Contos, M. J., Cales, W., Sterling, R. K., Luketic, V. A., Shiffman, M. L., Mills, A. S., Fisher, R. A., Ham, J., & Sanyal, A. J. (2001). Development of nonalcoholic fatty liver disease after orthotopic liver transplantation for cryptogenic cirrhosis. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 7(4), 363-73.
Contos MJ, et al. Development of Nonalcoholic Fatty Liver Disease After Orthotopic Liver Transplantation for Cryptogenic Cirrhosis. Liver Transpl. 2001;7(4):363-73. PubMed PMID: 11303298.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Development of nonalcoholic fatty liver disease after orthotopic liver transplantation for cryptogenic cirrhosis. AU - Contos,M J, AU - Cales,W, AU - Sterling,R K, AU - Luketic,V A, AU - Shiffman,M L, AU - Mills,A S, AU - Fisher,R A, AU - Ham,J, AU - Sanyal,A J, PY - 2001/4/17/pubmed PY - 2001/6/8/medline PY - 2001/4/17/entrez SP - 363 EP - 73 JF - Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society JO - Liver Transpl. VL - 7 IS - 4 N2 - Many subjects with cryptogenic cirrhosis have underlying nonalcoholic steatohepatitis (NASH). The natural history of NASH-related cryptogenic cirrhosis after orthotopic liver transplantation (OLT) is not well defined. A primarily retrospective study of patients with the clinical histological phenotype of NASH-related cirrhosis undergoing OLT was performed. Data were compared 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 protocol. 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 elevated enough to warrant diagnostic biopsy. Twenty-seven subjects with cryptogenic cirrhosis and a clinical histological phenotype of NASH and 3 patients 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-up of 3.5 +/- 2.7 years, 2 additional patients died of sepsis. There was a time-dependent increase in the risk for allograft steatosis that approached 100% by 5 years compared with only an approximately 25% incidence of steatosis in the control groups (P <.009, log-rank test). On multivariate analysis, only the cumulative steroid dose correlated with time to development of allograft steatosis. Three patients developed histological progression from hepatic steatosis to steatohepatitis. Of these, 1 patient developed progressive fibrosis. Four patients experienced at least 1 episode of acute cellular rejection; however, no patient developed chronic rejection or graft failure. In conclusion, nonalcoholic fatty liver disease occurs frequently after OLT in patients with the phenotype of NASH-related cirrhosis. Despite the frequent histological recurrence of disease, clinical outcomes are similar to those of other groups of patients undergoing OLT. SN - 1527-6465 UR - https://www.unboundmedicine.com/medline/citation/11303298/Development_of_nonalcoholic_fatty_liver_disease_after_orthotopic_liver_transplantation_for_cryptogenic_cirrhosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1527646501318750 DB - PRIME DP - Unbound Medicine ER -