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

Narayanan, Praveena, MD1; Mara, Kristin, MS2; Izzy, Manhal, MD1; Dierkhising, Ross, MS2; Heimbach, Julie, MD3; Allen, Alina M., MD3; Watt, Kymberly D., MD3

doi: 10.1097/TP.0000000000002317
Original Clinical Science—Liver

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.

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.

Received 10 April 2018. Revision received 9 May 2018.

Accepted 4 June 2018.

The authors declare no funding or conflicts of interest.

P.N. participated in the performance of research and writing of the article. K.M. participated in the data analysis and study design. M.I. participated in the performance of research and writing the article. R.D. participated in data analysis. J.H. participated in writing the article. A.M.A participated in writing the article. K.D.W. participated in the study design, performance of research, and writing the article.

Correspondence: Kymberly D. Watt, Division of Gastroenterology and Hepatology, William J vonLeibig Transplant Center, 200 First St SW, Rochester, MN 55905. (

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