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Transplantation. 2019 Jan;103(1):e14-e21. doi: 10.1097/TP.0000000000002317.

Recurrent or De Novo Allograft Steatosis and Long-term Outcomes After Liver Transplantation.

Author information

1
Mayo Clinic School of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN.
2
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
3
William J VonLeibig Transplant Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.

Abstract

BACKGROUND:

Hepatic steatosis is strongly associated with cardiovascular disease in the general population. Whether recurrent or de novo, it can occur in the allograft, but the impact on survival and long-term clinical outcomes remains unclear. In this study, we aim to determine both the frequency and impact of allograft steatosis on long-term posttransplant outcomes.

METHODS:

A retrospective review of 588 adult liver transplant (LT) recipients (1999-2006) was performed. Cox regression analysis (time-dependent) was used to evaluate differences in time to steatosis post-LT, patient survival, and cardiovascular outcomes.

RESULTS:

Mean age 51.9 ± 10.6 years, 64.6% males, underlying nonalcoholic steatohepatitis (NASH) (9.4%), previous tobacco (52%), pre-LT diabetes mellitus (30.3%), pre-LT hypertension (23.2%), and known cardiovascular disease (9.7%). Overall, 254 recipients developed allograft steatosis (at 10 years: 77.6% NASH recipients, 44.7% Non-NASH recipients). Risk factors for allograft steatosis were female sex (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.09-2.00; P = 0.014), hepatitis C virus diagnosis (HR, 2.49; 95% CI, 1.77-3.94; P < 0.001), and time-dependent BMI (per unit: HR, 1.08; 95% CI, 1.05-1.10; P < 0.001). Allograft steatosis was not associated with post-LT survival (P = 0.25) nor cardiovascular events (HR, 1.08; 95% CI, 0.73-1.59; P = 0.70). Underlying NASH associated with cardiovascular events (HR, 2.04; 95% CI, 1.37-3.04; P < 0.001).

CONCLUSIONS:

Allograft steatosis is common but not associated with survival or cardiovascular events in this study. Larger prospective studies are needed to better define the natural history of allograft steatosis.

PMID:
29994981
DOI:
10.1097/TP.0000000000002317
[Indexed for MEDLINE]

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