Recurrent or De Novo Nonalcoholic Fatty Liver Disease After Liver Transplantation: Natural History Based on Liver Biopsy Analysis

Nonalcoholic fatty liver disease (NAFLD) is a potential long-term complication after liver transplantation (LT) and can occur as recurrent disease in patients undergoing transplantation for NAFLD or as de novo NAFLD in others. The aim of this study was to compare these 2 different entities. From a cohort of adult patients undergoing transplantation between 2000 and 2010, we selected all patients with a diagnosis of NAFLD made during liver biopsy examinations during post-LT follow-up; clinical, biological, and histological features of patients with recurrent NAFLD and patients with de novo NAFLD were compared. The diagnosis of post-LT NAFLD was made for 91 patients during the study period: 11 cases were classified as recurrent NAFLD, and 80 cases were classified as de novo NAFLD. The groups were not statistically different with respect to the sex ratio, age, prevalence of hypercholesterolemia, prevalence of obesity, or prevalence of hypertension. The prevalence of diabetes mellitus was higher in patients with recurrent NAFLD (100% versus 37.5%, p < 0.01). At 5 years, severe fibrosis (stage 3 or 4) and steatohepatitis were more frequent in patients with recurrent NAFLD versus patients with de novo NAFLD [71.4% versus 12.5% (P < 0.01) and 71.4% versus 17.2% (P < 0.01), respectively]. NAFLD was already present in 67% of the patients with de novo NAFLD and in 100% of the patients with recurrent NAFLD after 1 year. According to successive liver biopsies, steatosis disappeared in 18 patients (22.5%) with de novo NAFLD and in none of the patients with recurrent NAFLD. In conclusion, our results strongly suggest that recurrent NAFLD and de novo NAFLD after LT are different entities; recurrent NAFLD appears to be a more severe and irreversible disease with an earlier onset.