Liver transplantation for nonalcoholic fatty liver disease: New challenges and new opportunities

Table 1 Summary of studies that evaluated post-transplant nonalcoholic fatty liver disease and metabolic syndrome

Ref.	Patient (n)	Follow up period	Outcomes post OLTn(%)	Metabolic syndrome post OLT
Kim et al[25]	8	15 mo	5/8 (63) → NAFL in 4 mo	BMI was higher in patients that developed steatosis
			1/8 (13) → NASH in 6 wk	Hyperlipidemia was observed in 5 patients who developed steatosis
			No cirrhosis within the follow up period
Contos et al[22]	30	> 4 yr	4/27 (15) → NAFL in 6 mo	BMI and steroid use were higher in patients that developed steatosis
			1/27 (4) → NASH in 1 yr	DM prevalence was higher post OLT
			2/27 (7) → NASH in 3 yr
			3/27 (11) → NASH in > 4 yr
			1/30 (3) → cirrhosis, no time range was specified
Charlton et al[57]	31	> 4 yr	9/15 (60) → NAFL in 4 mo	MetS was observed more in the post-transplant setting
			2/15 (13) → NASH in 4 mo	No detailed reports on MetS components
			4/15 (27) → NASH in 1 yr
			5/15 (33) → NASH in 2 yr
			3/15 (20) → fibrosis < 1 yr
			5/15 (33) → cirrhosis in > 4 yr
Ayata et al[58]	9	2 yr	Didn’t report steatosis or cirrhosis	No detailed report on post OLT metabolic syndrome
			2/9 (22) → NASH in 2 yr
Seo et al[7]	68	> 4 yr	12/68 (18) → NAFL, no time range was specified	MetS was higher in post OLT
				BMI increased in 35%
				HTN developed in 69%
			6/68 (9) → NASH, no time range was specified	DM was developed in 38%
			Did not report cirrhosis	Hypertriglyceridemia in 25%
Malik et al[59]	98	Around 2 yr	36/79 (45) → NAFL in 1 yr	MetS was higher post OLT and
		(461 d)		BMI increased post OLT
			19/79 (24) → NASH in < 2 yr	HTN developed more frequently post OLT
				DM was higher post OLT compared to pre-transplant period
			14/79 (18) in < 2 yr	Hypertriglyceridemia was higher in post OLT setting
Bhagat et al[21]	71	4 yr	Didn’t report steatosis	BMI increased in 17%
				HTN developed in 35%
			21/64 (33) → NASH in 6 mo	DM was developed in 16%
			No cirrhosis in 4 yr	Hypertriglyceridemia in 18%
Yalamanchili et al[60]	227	20 yr	8.2% → NAFL in 1 yr	BMI increased post OLT and statistically significant compared to pre transplant BMI
			13.6% → in 2 yr	HTN developed in 52%
			25% → NAFL in 5 yr	DM developed in 36%
			33% → NAFL in 10 yr
			6% → NASH 20 yr
			5% → cirrhosis in 5 yr
			10% → cirrhosis in 10 yr
Finkenstedt et al[20]	237	5 yr	11.6% → NAFL in 1 yr	BMI was higher in patients with steatosis 28.7 compared to those without 25.4 (P = 0.005)
			27.5% → NAFL in 3 yr
			32.6% → NAFL in 5 yr	DM was higher in patients who developed steatosis
			No biopsies, no report on NASH	HTN development was not different between groups
			No cirrhosis by imaging in 5 yr	Hypertriglyceridemia did not show difference

BMI: Body mass index; MetS: Metabolic syndrome; DM: Diabetes mellitus; HTN: Hypertension; NAFL: Nonalcoholic fatty liver (steatosis); NASH: Nonalcoholic steatohepatitis; OLT: Orthotopic liver transplantation.