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Post-liver transplant steatosis increases over time

Steatosis was common among liver transplantation recipients and increased over time from post-transplant, according to data from a retrospective analysis.

“Our study is the first to describe the occurrence, evolution and significance of fatty liver in a large unselected population of European liver transplant recipients,” Irena Hejlová, MD, of the hepatogastroenterology department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic, said in a press release. “Occurrence of fatty liver could indicate those patients whose long-term survival might be impaired.”

The researchers evaluated 2,360 post-liver transplant (LT) liver biopsies of 548 LT recipients to compare survival between those with significant steatosis and patients with grade 0 or 1 steatosis.

Results showed that 56.4% of patients had steatosis (n = 309), of which 17% had significant steatosis (n = 93).

The prevalence of steatosis increased from 30.3% at 1-year post-LT to 47.6% at 10-years post-LT (P < .001). This showed that post-transplant steatosis was not associated with worse patient survival within several years. However, the long-term survival of patients with significant steatosis tended to be worse.

The incidence of steatosis did not change significantly over time since LT (P = .85).

Data from multivariate analysis of pre-transplant factors and initial immunosuppression showed that alcohol-induced cirrhosis (P < .001) and high BMI (P = .002) were associated with the development of significant steatosis. Variables that appeared to protect against significant steatosis included increased levels of alkaline phosphatase (P = .01) and initial use of mycophenolate mofetil (P = .009).

Data from multivariate analysis of post-transplant factors showed that high BMI (P < .001), serum triglycerides (P < .001), alcohol consumption (P = .005) and type 2 diabetes mellitus (P = .048) were associated with significant steatosis. The only variable that appeared to protect against significant steatosis included high creatinine (P = .02).

Significant steatosis was not associated with a higher fibrosis stage (P = .62), according to the research.

To avoid development of fatty liver to avoid steatosis, Hejlova stated in the release: “Obesity should be avoided and patients should be encouraged to increase their physical activity. Screening and treatment of diabetes and hyperlipidemia should also be performed, and naturally, liver transplant recipients should abstain from alcohol consumption.”

The researchers concluded: “Besides recipient factors, overlapping with known risk factors of the general population, the type of [immunosuppression] may affect the development of steatosis with the potential protective effect of [mycophenolate mofetil] given initially after LT. Our data do not provide evidence for a major role of post-transplant steatosis on fibrosis progression, graft function and patient survival.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.