Insights Into NASH-Related Cirrhosis: Clinical and Histopathological Perspectives From Liver Transplant Specimens

Non-alcoholic fatty liver disease (NAFLD) is a common hepatic disease. In the cirrhotic phase, the characteristic manifestations of non-alcoholic steatohepatitis (NASH) disappear, making a diagnosis challenging. During January 2018 and December 2022, all explanted livers with a pre-transplantation clinical diagnosis of NASH-related cirrhosis were included in this study. The clinical data of the patients, the disease duration prior to transplant, and laboratory data were extracted from documents. Concurrently, the hematoxylin and eosin (H&E) slides and special stains were examined. Among the 2229 liver transplantations, 242 cases (11%) were due to the clinical diagnosis of pure NASH (71% = male, 29% = female). The patients' ages ranged from 28 to 74 years. The criteria for diagnosing NASH, including steatosis, ballooning degeneration, and lobular inflammation, were present in only 66%, 47%, and 3% of cirrhotic livers, respectively. Glassy cytoplasm, glycogenated nuclei, and small cell change were other common histologic features. Diagnosis of NASH in the cirrhotic phase is challenging because the characteristic features of NASH, particularly steatosis, may be non-significant or even completely disappear. In this situation, other histological findings, such as glycogenated nuclei or glassy cytoplasm, may help suggest NASH as a potential diagnosis.