Non-alcoholic fatty liver disease after liver transplantation: A lifestyle reloaded

Lubomir Skladany, Jana Badinkova, Svetlana Adamcova-Selcanova

Abstract


BACKGROUND AND AIMS

Apart from non-alcoholic steatohepatitis (NASH) as the sole etiology behind liver transplantation (LTx), non-alcoholic fatty liver disease (NAFLD)/NASH can play an important role in all the remaining etiologies of LTx. To gauge such a contribution of NAFLD/NASH, authors made use of 2 assumptions: a) there is tendency post-LTx to regain body shape (including obesity and its metabolic consequences) patients (pts) had before decompensation of their liver disease, therefore b) post-LTx fatty liver index (FLI) ≥ 60 (sensitivity/specificity for  NAFLD>85%) might reflect NAFLD pre-LTx.

 

METHODS

a) A retrospective study of body mass index (BMI) in the 6th and 12th moths (m) after LTx, b) a cross-sectional study of  FLI (and ultrasonography) > 6 m after LTx (Jana Badinková (JB), october 2015). a) An analysis of the medical records of pts after LTx performed in transplantation centre (TC) Banska Bystrica (BB). Interval studied: January 2011 – march 2016 (JB). Source of data: Hospital Information System (Care Centre® Copyright 2000, CGM, Version 3.33.2). Inclusion criteria: LTx in TC BB > 6 m ago. Exclusion criteria: LTx due to NASH; insufficient data for a FLI calculation. b) All the pts selected by inclusion/exclusion criteria were contacted by a TC physician (JB) via mobile phone (text message, or phone call) in order to determine current waist circumference.  Recorded variables: gender; age; etiology of advance chronic liver disease; BMI; ultrasonography; FLI (triacylglycerides, gamma-glutamyltransferase, waist circumference (cm), height (m), weight (kg)). Overweight was defined as a BMI > 25 kg/m2, obesity as a BMI > 30. An FLI > 60 was the value that indicated NAFLD.

RESULTS

From January 2011 to December 2015, 90 pts underwent LTx in TC BB. The inclusion  criteria were met by 87 of them, 40 pts were subsequently excluded. The cohort for final analysis consisted of 47 pts. Average age – 51 years (22-65); women - 25 (53%); indications for LTx: alcoholic liver disease – 22 pts (46%), autoimmune hepatitis - 7 pts (15%), primary sclerosing cholangitis – 6 pts (13%), primary biliary cholangitis - 5pts (11%), chronic hepatitis C – 3 pts (6,5%), chronic hepatitis B - 3pts (6,5%), other – 1 pt (2%). Average time from LTx to FLI measurement was 33 m (6-53). Overweight, and obesity 6 m after LTx: 22 pts (47%), and 5 pts (11%), respectively; 12 m after LTx - 21 pts (45%), and 9 pts (19%), respectively. FLI > 60 was found in 20 pts (43%). Twelve of 20 pts (60%) with FLI > 60 had an ultrasonography without the signs of steatosis.

 CONCLUSIONS

Provided the validity of assumptions that a) LTx restores pre-LTx-pre-decompensation body shape, and therefore b) FLI post-LTx is similar to FLI pre-LTx-pre-decompensation, the real contribution of NAFLD/NASH to LTx burden could be much greater than that derived from isolated NASH-LTx numbers. In this small cohort of pts transplanted for non-NASH etiologies, pre-LTx NAFLD could have been present in as much as 43% of pts.


Keywords


NAFLD – non-alcoholic fatty liver disease; LTx - liver transplantation; BMI – body mass index; FLI – fatty liver index; lifestyle

Full Text:

PDF

References


De Franchis R., Baveno IV Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015 Sep; 63(3):743-52.

Blachier M, Leleu H, Peck-Radosavljevic M at al. The burden of liver disease in Europe: A review of available epidemiological data. J Hepatol 2013; 58: 593-608.

European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016; 64(6):1388-402.

Skladaný Ľ. Portálna hypertenzia v praxi. Gastroenterol. prax 2015;14(1):4.

Wong RJ, Aguilar M, Cheung R, Perumpail RB, Harrison SA, Younossi ZM et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology 2015; 148(3):547 – 555.

Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver diesase demonstrates an exponential increase in burden of disease. Hepatology 2017; Accepted author manuscript. doi:10.1002/hep.29466

Rác M., Koller T., Klepanec A., Vaňo I., Streško M., Jarčuška P., Skladaný Ľ. 2017. Nealkoholová tuková choroba pečene a hepatocelulárny karcinóm: Prehľad a analýza nitrianskeho súboru. Interná med. 2017; 17(4):167-174.

Pais R, Charlotte F, Fedchuk L, Bedossa P, Lebray P, Poynard T et al. A systematic review of follow-up biopsies reveals disease progression in patients with non-alcoholic fatty liver. J Hepatol. 2013; 59(3):550-556.

Nadler JL. Diabetes and non-alcoholic steatohepatitis: Is there a connection?. International conference of fatty liver, 2017 June 1-3; Sevilla, Spain.

Karajamaki A.J., Bloigu R., Kauma H., Kesaniemi Y.A., Koivura O.P., Perkiomaki J. et al. Non-alcoholic fatty liver disease with and without metabolic syndrome: Different long-term outcomes. Metabolism, 2017; 66:55-63.

Sung KC, Wild SH, Byrne CD. Resolution of fatty liver and risk of incident diabetes. J Clin Endocrinol Metab. 2013; 98(9):3637-3643.

Kwok R., Choi K.C., Wong G.L., Zhang Y., Chan H.L., Luk A.O. et al. Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study. Gut, 2016; 65(8):1359-1368.

Argo C.K., Caldwell S.H. Epidemiology and natural history of non-alcoholic steatohepatitis. Clin Liver Dis, 2009; 13(4), 511-531.

Fábryová Ľ. Epidemiológia a zdravotné dôsledky obezity. Via practica, 2015; 12(1):8-14.

Szántová M., SkladanýĽ., Ďurkovičová. Epidemiologic survey of lifestyle factors in Slovakia outpatients, 2 Praque European Days of Internal Medicine; 2016 Dec 1-2; Praque, Czech Republic

Holomáň J., Slobodová Ľ. Cirhóza pečene a portálna hypertenzia – významné celospoločenské bremeno. Gatroenterol.prax, 2015; 14(1):5-8.

Fábryová Ľ. Artériová hypertenzia a diabetes mellitus – pohľad diabetológa. Via practica, 2011; 8(4):156-160.

Pincock S., Zimmet P. Fighting the „diabesity“ pandemic. Lancet, 2006; 368(9548), 1643.

Younossi Z, Henry L. Contribution of alcoholic and nonalcoholic fatty liver disease to the burden of liver –related morbidity and mortality. Gastroenterology, 2016; 15(8):1778-1785.

Bedogni G., Miglioli L., Masutti F., Castiglione A., Crocè L.S., Tiribelli C., Bellentani S. Incidence and natural course of fatty liver in the general population: the Dionysos study. Hepatology, 2007; 46(5):1387–1391.

Vallin M., Guillaud O., Boillot O., Hervieu V., Scoazec J.Y., Dumortier J. Reccurent or de novo noalcoholic fatty liver disease after liver transplantation: natural history based on liver biopsy analysis. Liver Transplant, 2014; 20(9):1064-1071.

Younossi Z, Anstee QM, Marietti M, Hardy T, Henry L, Eslam M et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat rev Gastroenterol Hepatol. 2017;. doi: 10.1038/nrgastro.2017.109. [Epub ahead of print]

Genel S., Coroian, Valer D., Floca E. Is the Non-Alcoholic Fatty Liver Disease Part of Metabolic Syndrome? J Diabetes Metab, 2015; 6:526.

Lomonaco R, Chen J, Cusi K. An Endocrine Perspective of Nonalcoholic Fatty Liver Disease (NAFLD). Therapeutic Advances in Endocrinology and Metabolism. 2011;2(5):211-225.

Bellentani S, Scaglioni F,Marino M, Bedogni G. Epidemiology of non-alcoholic fatty liver disease. Dig Dis, 2010; 28(1):155-161.

Patil, D. T. and Yerian, L. M. Evolution of nonalcoholic fatty liver disease recurrence after liver transplantation. Liver Transpl, 2012; 18(10):1147–1153.

Neuschwander-Tetri BA, Caldwell SH. Nonalcoholic steatohepatitis: summary of an AASLD single topic conference. Hepatology; 2003; 37(5):1202-1219.

Brown TG, Kleiner DE. Histopathology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Meatbolism 2016; 65(8):1080-186.

Machado M.V., Cortez-Pinto H. Non-invasive diagnosis of non-alcoholic fatty liver disease. A critical appraisal. Journal of Hepatology, 2013; 58(5):1007-1019.

Dureja P., Mellinger J., Agni R., Chang F., Avey G., Lucey M., Said A. NAFLD reccurence in liver transplant recipients. Transplantation, 2011; 91(6):684-689.

Malik SM, deVera ME, Fontes P, Shaikh O, Ahmad J. Outcome after liver transplantation for NASH cirrhosis. Am J Transplant. 2009; 9:782-793.

Heuer M., Kaiser G.M., Kahraman A., Banysch M., Saner F.H., Mathe Z. et al. Liver transplantation in nonalcoholic steatohepatitis is associated with high( mortality and post-transplant complications: a single-center experience. Digestion, 2012; 86(2):107–113.

Charlton M.R., Burns J.M., Pedersen R.A., Watt K.D., Heimbach J.K., Dierkhising R.A. 2011. Frequency and outcomes of liver transplantation for nonalcoholic steatohepatitis in the United States. Gastroenterology, 2011; 141(4): 1249–1253.

Burke GW, Cirocco R, Hensley G, Ranjan D, Reddy R, Jeffers L, et al. Liver transplantation for cirrhosis following jejuno-ileal bypass-- regional cytokine differences associated with pathological changes in the transplant liver. Transplantation. 1992; 54:374–377.

Khullar V, Dolganiuc A, Firpi RJ. Pre-and- post transplant considerations in patients with nonalcoholic fatty liver disease. World J Transplant, 2014; 4(2):81-92.

Contos MJ, Cales W, Sterling RK, Luketic VA, Shiffman VA, Mills AS et al. Development of nonalcoholic fatty liver disease after orthotopic liver transplantation for cryptogenic cirrhosis. Liver Transpl. 2001; 7(4):363-373.

Wong R.J., Aguilar M., Cheung R., Perumpail R.B., Harrison S.A., Younossi Z.M. et al. Nonalcoholic Steatohepatitis Is the Second Leading Etiology of Liver Disease Among Adults Awaiting Liver Transplantation in the United States. Gastroenterology, 2015; 148(3):547 –555.

Yang JD, Larson JJ, Watt KD, Allen AM, Wiesner RH, Gores GJ et al. Hepatocellular carcinoma is the most common indication for liver transplantation and placement on the waitlist in the United States. Clincal gastroenterology and hepatology, 2017; 15:767-775.

Dyson J., Jaques B., Chattopadyhay D., Lochan R., Graham J., Das D. et al. Hepatocellular cancer: The impact of obesity, type 2 diabetes and a multidisciplinary team. Journal of Hepatology, 2014; 60(1):110-117.

Flemming, J. A., Kim, W. R., Brosgart, C. L. and Terrault, N. A. Reduction in liver transplant wait-listing in the era of direct-acting antiviral therapy. Hepatology 2017; 65:804–812.

Patel Y.A., Berg C.L., Moylan C.A. Nonalcoholic fatty liver disease: Key Considerations before and after liver trasnplantation. Dig Dis Sci, 2016; 61(5):1406-1416.

Hejlová I., Honsová E., Šticová E., Lanská V., Hucl T., Špičák J., Trunečka P. Prevalence and risk factors of steatosis after liver transplantation and patients outcomes. Liver Transplant, 2016; 22(5):644-655.

Charlton M.R., Burns J.M., Pedersen R.A., Watt K.D., Heimbach J.K., Dierkhising R.A. Frequency and outcomes of liver transplantation for nonalcoholic steatohepatitis in the United States. Gastroenterology, 2011; 141(4):1249–1253.

Yalamanchili K., Saadeh S., Klintmalm G.B., Jennings L.W., Davis G.L. Nonalcoholic fatty liver disease after liver transplantation for cryptogenic cirrhosis or nonalcoholic fatty liver disease. Liver transpl, 2010; 16(4):431-439.

Bhati C, Idowu MO, Sanyal AJ, Rivera M, Driscoll C, strawitz RT, Kohli DR et al. Long-term outcomes in patients undergoing liver transplantation for nonalcoholic steatohepatitis-related cirrhosis. Transplantation 2017; 101(8):1867-1874.

Finkenstedt, A. and Graziadei I. W. Steatosis after liver transplantation: Is it really benign? Liver Transpl, 2016; 22(5):585–587.

Charatcharoenwitthaya P., Pongpaibul A., Kaosombatwattana U., Bhanthumkomol P., Bandidnyamanon W., Pausawasdi N., Tamwandee T. The prevalence of steatohepatitis in chronic hepatitis B patients and its impact on disease severity and treatment response. Liv International, 2017; 37(4):542-551.

Kim WR, Poterucha JJ, Poravko MK, Dickson ER, Steers JL, Wiesner RH. Reccurence of nonalcoholic steatohepatitis following liver transplantation. Transplantation 1996;62(12):1802-1805.

Dumortier J., Giostra E., Belbouab S., Morard I., Guillaud O., Spahr L. Et al. Non-alcoholic fatty liver disease in liver transplant recipients: another story of “seed and soil”. Am J Gastroenterol, 2010; 105(3):613-620.

Burke A., Lucey M.R. Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steatohepatitis and Orthotopic Liver Transplantation. American Journal of Transplantation, 2004;4(5):686–693.

McAlistera VC, Haddada E, Renoufb E, Malthanera RA, Kjaerc MS, Gluudc LL. Cyclosporin versus tacrolimus as primary immunosuppressant after liver transplantation: A meta-analysisi. Am J Transplantation 2006; 6: 1578-1585.

Merola J., Liapakis A., Mulligan D.C., Yoo P.S. Non-alcoholic fatty liver disease following liver transplantation: a clinical review. Clinical Transplantation, 2015; 29(9):728-727.

Watt K.D., Charlton M.R. Metabolic syndrome and liver transplantation: a review and guide to management. J Hepatol., 2010; 53(1):199-206.

Seo S., Maganti, K., Khehra, M., Ramsamooj, R., Tsodikov, A., Bowlus, C. Et al. De novo nonalcoholic fatty liver disease after liver transplantation. Liver Transpl, 2007; 13(6):844–847.

Sprinzl M. F., Weinmann A., Lohse N., Tönissen H., Koch S., Schattenberg J. et al. Metabolic syndrome and its association with fatty liver disease after orthotopic liver transplantation. Transplant International, 2013; 26(1):67–74.

WHO, http:// www.who.int/mediacentre/factsheets/fs311/en/

Bedogni G., Bellentani S., Miglioli L., Masutti F., Passalacqua M., Castiglione A. et al. The fatty liver index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol, 2006; 6:33.

Hernaez R, Lazo M, Bonekamp S, Kamel I, Brancati FL, Guallar E et al. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology 2011; 54(3):1082 – 1090.

Szczepaniak LS, Nurenberg P, Leonard D, Browning JD, reingold JS, Grundy S et al. Magnetic resonance spectroscopy to measure hepatic triglyceride content: prevalence of hepatic steatosis in the general population. Am J Physiol Endocrinol Metab. 2005;288(2):462-468.

Shaker M., Tabbaa A., Albedawi M., Alkhouri N. Liver transplantation for non-alcoholic fatty liver disease: New challenges and new opportunities. World J gastroenterol 2014;20(18):5320-5330.

Everhart JE, Lombardero M, Lake JR, Wiesnes RH, Zetterman RK, Hoofnagle JH. Weight change and obesity after liver transplantation: incidence and risk factors. Liver Transpl Surg, 1998; 4(4):285-296.

Liu D, Ahmet A, Ward L, Krishnamoorthy, Mandelcorn ED, Leigh R et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013; 9(1):30.




DOI: http://dx.doi.org/10.5281/zenodo.1000968

Refbacks

  • There are currently no refbacks.




Copyright (c) 2017 © The Author(s)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Journal of Education, Health and Sport formerly Journal of Health Sciences

Declaration on the original version.

Editors indicates that the main version of the magazine is to issue a "electronic".

The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019.

1223 Journal of Education, Health and Sport eISSN 2391-8306 7

ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

Archives 2011 - 2014

PBN 2011 - 2014

https://pbn.nauka.gov.pl/sedno-webapp/search?search&searchCategory=WORK&filter.inJournal=36616

POL-index 2011 - 2014

https://pbn.nauka.gov.pl/polindex-webapp/browse/journal/journal-32a319c5-a850-4f44-ba70-1418a6087655

BASE 2011 - 2014

https://www.base-search.net/Search/Results?lookfor=Journal+of+Health+Sciences+%28Radom%29&type=all&oaboost=1&ling=1&name=&thes=&refid=dcrespl&newsearch=1

http://elibrary.ru/contents.asp?titleid=37467

http://journal.rsw.edu.pl/index.php/JHS/issue/archive

Indexed in Bases, Bazy indeksacyjne: ERIH Plus, Worldcat, PBN/POL-Index, ICI Journals Master List, Directory of Open Access Journals (DOAJ), ZBD, Ulrich's periodicals, Google Scholar, Polska Bibliografia Lekarska

US NLM = 101679844

101679844 - NLM Catalog Result - NCBI

https://www.ncbi.nlm.nih.gov/nlmcatalog/101679844

Find a library that holds this journal: http://worldcat.org/issn/23918306

Journal Language(s): English 

PBN Poland

https://pbn.nauka.gov.pl/sedno-webapp/journals/49068

POL-index

https://pbn.nauka.gov.pl/polindex-webapp/browse/journal/journal-c39c8169-88d2-45db-9e7f-d948ce9981c4

BASE

https://www.base-search.net/Search/Results?join=AND&bool0[]=AND&lookfor0[]=2391-8306&type0[]=all&page=11&l=pl&oaboost=1&refid=dcpagepl

Redaction, Publisher and Editorial Office

Instytut Kultury Fizycznej Uniwersytet Kazimierza Wielkiego w Bydgoszczy, Institute of Physical Education Kazimierz Wielki University in Bydgoszcz, Poland 85-091 Bydgoszcz ul. Sportowa 2  www.ukw.edu.pl Copyright by Instytut Kultury Fizycznej UKW w Bydgoszczy http://ojs.ukw.edu.pl/index.php/johs  Open Access ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

The journal has been approved for inclusion in ERIH PLUS.

The ERIH PLUS listing of the journal is available at https://dbh.nsd.uib.no/publiseringskanaler/erihplus/periodical/info?id=485984

SIC Science citation index (calculated on the basis of TCI and Page Rank) 0

Russian Impact factor 0.16

Indexed in Index Copernicus Journals Master List.

http://journals.indexcopernicus.com/Journal+of+Education+Health+and+Sport,p24782242,3.html

ICV 2018 = 95.95 ICV 2017 = 91.30 ICV 2016 = 84.69 ICV 2015 = 93.34 ICV 2014 = 89.51 Standardized Value: 8.27 ICV 2013: 7.32 ICV 2012: 6.41 ICV 20115.48

The InfoBase Index IBI Factor for the year 2015 is 3.56 in InfoBase Index.com.

Website: www.infobaseindex.com

Universal Impact Factor 1.78 for year 2012. (http://www.uifactor.org/AppliedJournals.aspx)

Indexed in Polish Scholarly Bibliography (PBN) (PBN Polska Bibliografia Naukowa) (https://pbn.nauka.gov.pl/journals/36616)

is a portal of the Polish Ministry of Science and Higher Education, collecting information on publications of Polish scientists and on Polish and foreign scholarly journals. Polish Scholarly Bibliograhpy is a part of POL-on - System of Information on Higher Education. It is operated by the Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw.

Indexed in Russian Sciences Index Российский индекс научного цитирования (РИНЦ) http://elibrary.ru/contents.asp?titleid=37467

Indexed in Arianta Polish scientific and professional electronic journals Aneta Drabek i Arkadiusz Pulikowski

(http://www1.bg.us.edu.pl/bazy/czasopisma/czasop_full.asp?id=3595)