Hepatic steatosis after pediatric liver transplant

Emily R. Perito, Tabitha Vase, Rageshree Ramachandran, Andrew Phelps, Kuang-Yu Jen, Robert H. Lustig, Vickie A. Feldstein, Philip Rosenthal

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Hepatic steatosis develops after liver transplantation (LT) in 30% of adults, and nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in nontransplanted children. However, posttransplant steatosis has been minimally studied in pediatric LT recipients. We explored the prevalence, persistence, and association with chronic liver damage of hepatic steatosis in these children. In this single-center study of pediatric patients transplanted 1988-2015 (n = 318), 31% of those with any posttransplant biopsy (n = 271) had ≥ 1 biopsy with steatosis. Median time from transplant to first biopsy with steatosis was 0.8 months (interquartile range [IQR], 0.3-6.5 months) and to last biopsy with steatosis was 5.5 months (IQR, 1.0-24.5 months); 85% of patients with steatosis also had for-cause biopsies without steatosis. All available for-cause biopsies were re-evaluated (n = 104). Of 9 biopsies that could be interpreted as nonalcoholic steatohepatitis (NASH)/borderline NASH, with steatosis plus inflammation or ballooning, 8 also had features of cholestasis or rejection. Among 70 patients with surveillance biopsies 3.6-20.0 years after transplant, only 1 overweight adolescent had a biopsy with NAFLD (grade 1 steatosis, mild inflammation, no ballooning or fibrosis)—despite a 30% prevalence of overweight/obesity in the cohort and 27% with steatosis on previous for-cause biopsy. Steatosis on preceding for-cause biopsy was not associated with portal (P = 0.49) or perivenular fibrosis (P = 0.85) on surveillance biopsy. Hepatic steatosis commonly develops early after transplant in children and adolescents, but it rarely persists. Biopsies that did have steatosis with NASH characteristics were all for-cause, mostly in patients with NAFLD risk factors and/or confounding causes of liver damage. Prospective studies that follow children into adulthood will be needed to evaluate if and when hepatic steatosis presents a longterm risk for pediatric LT recipients. Liver Transplantation 23 957–967 2017 AASLD.

Original languageEnglish (US)
Pages (from-to)957-967
Number of pages11
JournalLiver Transplantation
Volume23
Issue number7
DOIs
StatePublished - Jul 1 2017

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Pediatrics
Transplants
Biopsy
Liver
Liver Transplantation
Fibrosis
Inflammation
Cholestasis
Non-alcoholic Fatty Liver Disease
Liver Diseases
Chronic Disease
Obesity
Prospective Studies

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Perito, E. R., Vase, T., Ramachandran, R., Phelps, A., Jen, K-Y., Lustig, R. H., ... Rosenthal, P. (2017). Hepatic steatosis after pediatric liver transplant. Liver Transplantation, 23(7), 957-967. https://doi.org/10.1002/lt.24773

Hepatic steatosis after pediatric liver transplant. / Perito, Emily R.; Vase, Tabitha; Ramachandran, Rageshree; Phelps, Andrew; Jen, Kuang-Yu; Lustig, Robert H.; Feldstein, Vickie A.; Rosenthal, Philip.

In: Liver Transplantation, Vol. 23, No. 7, 01.07.2017, p. 957-967.

Research output: Contribution to journalArticle

Perito, ER, Vase, T, Ramachandran, R, Phelps, A, Jen, K-Y, Lustig, RH, Feldstein, VA & Rosenthal, P 2017, 'Hepatic steatosis after pediatric liver transplant', Liver Transplantation, vol. 23, no. 7, pp. 957-967. https://doi.org/10.1002/lt.24773
Perito ER, Vase T, Ramachandran R, Phelps A, Jen K-Y, Lustig RH et al. Hepatic steatosis after pediatric liver transplant. Liver Transplantation. 2017 Jul 1;23(7):957-967. https://doi.org/10.1002/lt.24773
Perito, Emily R. ; Vase, Tabitha ; Ramachandran, Rageshree ; Phelps, Andrew ; Jen, Kuang-Yu ; Lustig, Robert H. ; Feldstein, Vickie A. ; Rosenthal, Philip. / Hepatic steatosis after pediatric liver transplant. In: Liver Transplantation. 2017 ; Vol. 23, No. 7. pp. 957-967.
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abstract = "Hepatic steatosis develops after liver transplantation (LT) in 30{\%} of adults, and nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in nontransplanted children. However, posttransplant steatosis has been minimally studied in pediatric LT recipients. We explored the prevalence, persistence, and association with chronic liver damage of hepatic steatosis in these children. In this single-center study of pediatric patients transplanted 1988-2015 (n = 318), 31{\%} of those with any posttransplant biopsy (n = 271) had ≥ 1 biopsy with steatosis. Median time from transplant to first biopsy with steatosis was 0.8 months (interquartile range [IQR], 0.3-6.5 months) and to last biopsy with steatosis was 5.5 months (IQR, 1.0-24.5 months); 85{\%} of patients with steatosis also had for-cause biopsies without steatosis. All available for-cause biopsies were re-evaluated (n = 104). Of 9 biopsies that could be interpreted as nonalcoholic steatohepatitis (NASH)/borderline NASH, with steatosis plus inflammation or ballooning, 8 also had features of cholestasis or rejection. Among 70 patients with surveillance biopsies 3.6-20.0 years after transplant, only 1 overweight adolescent had a biopsy with NAFLD (grade 1 steatosis, mild inflammation, no ballooning or fibrosis)—despite a 30{\%} prevalence of overweight/obesity in the cohort and 27{\%} with steatosis on previous for-cause biopsy. Steatosis on preceding for-cause biopsy was not associated with portal (P = 0.49) or perivenular fibrosis (P = 0.85) on surveillance biopsy. Hepatic steatosis commonly develops early after transplant in children and adolescents, but it rarely persists. Biopsies that did have steatosis with NASH characteristics were all for-cause, mostly in patients with NAFLD risk factors and/or confounding causes of liver damage. Prospective studies that follow children into adulthood will be needed to evaluate if and when hepatic steatosis presents a longterm risk for pediatric LT recipients. Liver Transplantation 23 957–967 2017 AASLD.",
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