Evolution of nonalcoholic fatty liver disease recurrence after liver transplantation

Nonalcoholic steatohepatitis (NASH) is the progressive form of nonalcoholic fatty liver disease (NAFLD) and is the fourth most common indication for liver transplantation. Risk factors for NAFLD can persist and even worsen after liver transplantation. However, the risk and significance of NAFLD recurrence remain unclear. Reported posttransplant NAFLD and NASH recurrence rates vary widely across studies. There is little information detailing the histological evolution of NAFLD recurrence, and the long-term natural history of NAFLD recurrence is unclear. In this review, we summarize the findings of studies on the prevalence of recurrent NAFLD and its risk factors in the posttransplant setting, and we explore reasons for the discrepant reported recurrence rates. On the basis of currently available data, the relatively low rates of advanced fibrosis and NAFLD-associated graft loss and the comparability of the survival rates for these patients and patients undergoing transplantation for other diseases suggest that although NAFLD or NASH can recur, the clinical significance of disease recurrence for graft or patient survival may be small.