High prevalence of de novo metabolic dysfunction-associated fatty liver disease after liver transplantation and the role of controlled attenuation parameter

BMC Gastroenterology

Research

Tiffany CL Wong¹  Ka-Wan Chu¹  Wai-Kay Seto¹  Ka-Wing Ma¹  Chung-Mau Lo¹  Wong-Hoi She¹  Wing-Chiu Dai¹  Man-Fung Yuen¹  Lung-Yi Mak¹  Albert CY Chan¹  Sui-Ling Sin¹  James Fung¹ 

[1] Department of Medicine, The University of Hong Kong Queen Mary Hospital, 102 Pokfulam Road, Pok Fu Lam, Hong Kong;State Key Laboratory Research of Liver Research, The University of Hong Kong, Pok Fu Lam, Hong Kong;

关键词: NAFLD;    MAFLD;    VCTE;    CAP;    Liver transplantation;    Liver biopsy;    Metabolic syndrome;    Body mass index;   

DOI  :  10.1186/s12876-023-02940-y

 received in 2023-03-25, accepted in 2023-08-30,  发布年份 2023

来源: Springer

【 摘 要 】

Background & AimsAlthough non-alcoholic fatty liver disease (NAFLD) remains an uncommon indication for liver transplantation (LT) in the Chinese, the prevalence of NAFLD is increasing. We aimed to determine the prevalence of de novo steatosis and metabolic dysfunction-associated fatty liver disease (MAFLD) after LT.MethodsTransient elastography assessment for liver stiffness and controlled attenuation parameter (CAP) were performed after LT in 549 patients at median time of 77 months from LT. CAP was compared with implant liver biopsy, and also validated in 42 patients with post-LT liver biopsy. Longitudinal history including diabetes mellitus (DM), dyslipidemia, hypertension, and immunosuppressive regimen were recorded.ResultsThe optimal cut-off level of CAP for diagnosing at least mild (≥ S1) and moderate-to-severe steatosis (≥ S2/3) was 266 and 293 dB/m respectively, with AUROC of 0.740 and 0.954 respectively. Using this newly derived cut-off, 28.9% patients have de novo NAFLD, of which 95.6% fulfilled the criteria for MAFLD. After multivariate analysis, BMI (HR 1.34), DM (HR 2.01), hypertension (HR 2.03), HDL-cholesterol (HR 0.25), LDL-cholesterol (HR 1.5) and cryptogenic cirrhosis (HR 4.85) were associated with the development of S2/3 graft steatosis. de novo NAFLD was associated with higher incidence of new-onset hypertension (p < 0.001), graft dysfunction (defined as ALT > 40 U/L; p = 0.008), but not associated with graft fibrosis (defined as liver stiffness > 12 kPa; p = 0.761).ConclusionAlthough NAFLD remains an uncommon primary liver disease indication for LT in Chinese patients, post-transplant de novo graft steatosis is common and the majority is classified as MAFLD. Development of graft steatosis is not associated with an increase in graft fibrosis but was associated with worse metabolic control and graft dysfunction. Routine CAP measurement to detect de novo graft steatosis should be considered after LT regardless of the primary indication of LT.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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