Background: Patients with non-alcoholic steatohepatitis (NASH) can develop progressive liver dysfunction necessitating orthotopic liver transplantation (OLT). Incidence of disease recurrence and eventual outcome of the liver allograft in these patients have not been fully explored.
Methods: We reviewed the records of all patients undergoing OLT at our liver transplantation program. A complete evaluation, including definitive tests to exclude alternative causes of liver disease, was required for each patient prior to OLT. Patients transplanted for NASH were identified according to their explanted liver histology. Medical records were used to extract pre- and post-OLT data, including sequential body weight, biochemistry and graft histology.
Results: Of 622 liver explants, eight had exhibited morphologic and clinical features consistent with NASH. All patients were female with a median age of 58. Seven patients were diagnosed with NASH pre-operatively, including three who had undergone jejunoileal bypass, and one patient was diagnosed as cryptogenic cirrhosis. At a mean of 12.3 months following OLT (range: six weeks to four years), all of the eight patients were alive with no graft failure. However, six patients developed persistent fatty infiltration in their graft, three of whom with features sufficient for a diagnosis of recurrent NASH. The timing of recurrent steatosis ranged from three weeks to two years. In two patients, including one with jejunoileal bypass, transition from mild steatosis to severe steatosis and steatohepatitis was observed over one to two years. In addition, mild fibrosis was seen in both patients. Patients frequently had mild non-specific liver enzyme elevations. The patients who did not develop recurrent steatosis had significant weight loss following transplantation, although the length of follow-up was relatively short.
Conclusion: Patients undergoing OLT for end-stage liver disease as a result of NASH may develop recurrent steatosis shortly after transplantation, with possible progression to steatohepatitis and fibrosis. Although longer follow-up is necessary to determine the eventual prognosis related to the recurrent fat and fibrosis in the graft, OLT remains an effective treatment for this subgroup of patients.