Prevalence and Risk Factors of Hepatic Steatosis in Kidney Transplant Recipients

BACKGROUND Kidney failure and hepatic steatosis (HS) are core elements of cardiovascular-renal-metabolic syndrome. Evidence of HS in kidney transplant (KTx) recipients remains limited. We evaluated the prevalence and determinants of de novo hepatic steatosis (dnHS) after KTx. MATERIAL AND METHODS We retrospectively analyzed adult KTx recipients from a single outpatient center without HS prior to transplantation. Anthropometric data, laboratory results, comorbidities, and medication use were evaluated. HS was diagnosed based on ultrasonography. RESULTS In 127 (53 female) KTx recipients with median age of 56.91 (44.91-64.62) years and median estimated glomerular filtration rate of 39.6 (29.76-48.51) mL/min/1.73 m², 44 patients (30.1%) had dnHS. Patients in the dnHS and nonHS groups were of comparable age, sex, and graft function. Patients in the dnHS group had significantly higher body mass index (BMI) before (25.5±3.29 vs 23.26±3.55 kg/m²; P<0.001) and after KTx (27.86±4.06 vs 24.71±3.69 kg/m²; P<0.001), and dnHS was associated with higher rates of hyperlipidemia (77.3% vs 54.2%; P=0.012), hyperuricemia (52.3% vs 28.9%; P=0.009), and ischemic heart disease (34.1% vs 13.1%, P=0.006). In multivariable logistic regression, higher post-KTx BMI (OR=1.21; 95% CI, 1.08-1.37; P=0.002) and history of ischemic heart disease (OR=3.40; 95% CI, 1.18-9.74; P=0.023) were independently associated with the presence of dnHS. CONCLUSIONS Hepatic steatosis is common among KTx recipients and is strongly associated with metabolic comorbidity, particularly higher BMI and ischemic heart disease.