P0975 - Recurrence of NAFLD, NASH, and Cirrhosis After Liver Transplantation for NASH Cirrhosis

Ishaan Dharia, MD¹, Smruthi Rath, MD¹, Gene Im, MD^2
1Icahn School of Medicine at Mount Sinai, New York, NY; ²Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY

Introduction: Non-alcohol-associated steatohepatitis (NASH) is one of the leading causes of liver transplantation (LT) in the United States. While disease recurrence of conditions along the spectrum of non-alcohol-associated fatty liver disease (NAFLD) after LT is common, the natural history of their onset is poorly understood. The aim of this study is to determine the onset of recurrent NAFLD, NASH and cirrhosis after LT for NASH.

Methods: Using a prospectively maintained database, we performed a retrospective study of patients who underwent LT for NASH at our center (excluding hepatocellular carcinoma) from 1/1/2012 to 1/1/2023. We gathered and analyzed data regarding patient demographics, laboratory and radiology data, and patient survival. NAFLD recurrence was defined as the presence of steatosis on imaging after LT in the absence of regular alcohol use. NASH and NASH cirrhosis recurrence were defined by liver biopsy findings of steatohepatitis and stage 4 fibrosis, respectively. Descriptive and logistic regression statistical analyses were performed.

Results: Over the 11-year study period, 190 LTs for NASH were performed at our center. The average age was 66 years, with 54% men and 51% White race, indicative of a diverse recipient cohort (Table 1). Of these, 53 (28%) developed NAFLD recurrence at an average of 2.4 years after LT, diagnosed most commonly by transient elastography (42%) (Figure 1). Recurrent NAFLD diagnosed via transient elastography was seen on the first image completed; on average this was 2.6 years after LT. Average AST and ALT at the time of recurrent NAFLD diagnosis were 33 and 47 IU/L, respectively. In contrast, there were low rates of NASH and NASH cirrhosis recurrence, 4% (n=7) and 0, respectively. On average, recurrent NASH was diagnosed 2.7 years after LT. Average AST and ALT at time of NASH diagnosis were 80 and 86 IU/L, respectively. Notably, of the seven patients found to have biopsy-confirmed NASH, 2 (29%) did not have steatosis on imaging. Logistic regression analysis demonstrated that age, sex, and race were not significantly associated with recurrence of NAFLD or NASH (p< 0.05). Survival at 1 year was 92%, with an overall survival of 84%.

Discussion: In a large, diverse cohort of LT for NASH recipients with long-term follow-up, recurrence of NAFLD occurred in about one-quarter, with rare recurrent NASH and NASH cirrhosis. Our data suggests a potential role of transient elastography surveillance of recurrence of the NAFLD spectrum of diseases.




Disclosures:


Ishaan Dharia, MD¹, Smruthi Rath, MD¹, Gene Im, MD². P0975 - Recurrence of NAFLD, NASH, and Cirrhosis After Liver Transplantation for NASH Cirrhosis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.