Noninvasive markers of liver steatosis and fibrosis after liver transplantation – Where do we stand?

Table 1 Studies investigating the role of nonalcoholic fatty liver disease in post-liver transplant setting

Ref.	Type of the study	Study population	Follow up	Diagnostic method	Incidence of NAFLD	Major outcomes
Bhagat et al[11]	Retrospective	71 NAFLD, 81 alcoholic liver disease	Median 1517-1686 d	43.4% biopsy, 56.6% US	30% NAFLD, 0% alcoholic liver disease	NAFLD recurrence more common than de novo; acute cellular rejections more common in NAFLD group; no influence on CVD and overall mortality
Bhati et al[12]	Retrospective	103 NAFLD	Median 47-78 mo	90% biopsy or TE	87.5% steatosis (TE), reccurent NAFLD 88.2% (biopsy)	20.6% had bridging fibrosis (TE); advanced fibrosis (> F3) was seen in 26.8% (biopsy)
Seo et al[4]	Retrospective	68 non-NAFLD	Median 28 mo		18% de novo NAFLD, 9% NASH	Increase in BMI > 10% risk factor for de novo NAFLD; ACE-I protective role
Dumortier et al[14]	Retrospective	421 non-NAFLD	48 mo	Biopsy	53% had steatosis grade 1, 31% grade 2 and 16% grade 3 steatosis; 29% perisinusidal fibrosis; 3.8% NASH. 2.25% cirrhosis	MetS and its individual components, tacrolimus-based immunosuppressive therapy, alcoholic liver disease as the primary indication for LT and liver graft steatosis were associated with post-LT steatosis
Vallin et al[15]	Retrospective	80 de novo NAFLD, 11 recurrent NAFLD	5 yr		NASH and severe fibrosis (stages 3 and 4) were more common in recipients with recurrent than in those with de novo NAFLD (71.4% vs 12.5% and 71.4% vs 17.2%, respectively)	Recurrent NAFLD is a more severe disease with an earlier onset; prevalence of diabetes mellitus was higher in patients with recurrent NAFLD
Narayanan et al[19]	Retrospective	588 LT recipients; 9.7% NAFLD; 90.3% non-NAFLD	10 yr	41.5% biopsy, other US, CT, MR	Recurrent steatosis developed 77.6% and de novo 44.7%	Allograft steatosis did not influence post-LT survival or adverse CVD events, while underlying; NAFLD diagnosis was associated with a 2.04 increased risk of adverse cardiovascular events

LT: Liver transplantation; NAFLD: Nonalcoholic liver fatty disease; NASH: Nonalcoholic stetohepatitis, MeS: Metabolic syndrome; TE: Transient elastography; US: Ultrasound; CT: Computed tomography; BMI: Body mass index; ACE-I: Angiotensin converting enzyme inhibitors; MR: Magnetic resonance; CVD: Cardiovascular disease.