Úvod: Nealkoholová tuková choroba pečene (NAFLD) je najrýchlejšie rastúcou príčinou ochorení pečene. Pri vzniku po transplantácii pečene (LT) pre iné indikácie nesie názov de novo NAFLD. Cieľ: Stanoviť incidenciu de novo NAFLD a jej asociáciu s BMI a fibrózou po LT v jednom transplantačnom centre. Metódy: Medzi januárom 2015 a decembrom 2020 sme realizovali propektívnu observačnú štúdiu u po sebe nasledujúcich pacientov po LT pre iné indikácie ako NAFLD. Sledovali sme demografické ukazovatele, etiológiu cirhózy pečene, MELD sklóre a Child Pugh skóre. Šesť, 12 a 24 mesiacov po LT sme hodnotili BMI, MR spektroskopiu (MRS, [≥ 5 % = NAFLD]) a MR elastografiu (MRE, [≥ 2,88 kPa = signifikantná fibróza, ≥ 3,54 kPa = pokročilá fibróza]). Výsledky: V sledovanom intervale sme do štúdie zaradili 164 pacientov po LT. Na základe vopred definovaných kritérií sme vylúčili 37 pacientov, do finálnej analýzy sme zaradili 104 pacientov s mediánom 53 rokov, 38 % žien, s mediánom MELD 15 bodov a BMI 25,4. Medián BMI – 6, 12 a 24 mes. po LT bol 25,5 vs. 27,3 (p = 0,032) a 26 vs. 27,8 (p = 0,062). MRS % – 6, 12 a 24 mes. po LT boli 4,5 oproti 5,1 (p = 0,2) a 4,4 oproti 7 (p = 0,012). Šesť, 12 a 24 mesiacov po LT sme signifikantnú fibrózu zistili u 27 %, 35 % a 46 % (p = 0,09) a pokročilú fibrózu u 4,7 %, 1,2 % a 15 % pacientov (p = 0,003). Závery: Počas dvoch rokov po LT pre iné indikácie ako NAFLD sme zaznamenali stúpajúci trend BMI, stúpajúci výskyt de novo NAFLD, signifikantnej a pokročilej fibrózy.

Background: Non-alcoholic fatty liver disease (NAFLD) is the fastest-growing cause of liver diseases; after liver transplantation (LT) for another indications bears the name de novo NAFLD. Aims: We set out to determine the incidence of de novo NAFLD and its associations with BMI and fibrosis in patients (pts) after LT at a single transplant centre. Methods: We organized an observational study of consecutive pts after LT for non-NAFLD causes between January 2015 and December 2020. At the baseline, we recorded the demographics, etiology of cirrhosis, MELD and Child-Pugh score; 6, 12 and 24 months after LT we recorded BMI, MR spectroscopy (MRS, [≥5% = NAFLD]) and MR Elastography (MRE, [≥2.88 kPa = significant fibrosis, ≥3.54 kPa = advanced fibrosis]). Results: We enrolled 164 pts after LT, excluded 37% for pre-defined criteria and analysed 104 pts with median age 53 years, 38% women, with median MELD 15 points and BMI 25.4. The median BMI – 6, 12 and 24 months after LT – were 25.5 vs 27.3 (P = 0.032) and 26 vs 27.8 (p = 0.062). MRS % – 6, 12, and 24 months after LT were 4.5 vs 5.1 (P = 0.2) and 4.4 vs 7 (P = 0.012). Significant fibrosis 6, 12 and 24 months after LT were found in 27%, 35% and 46%, respectively (P = 0.09), and advanced fibrosis in 4.7%, 1.2% and 15%, respectively (P = 0.003). Conclusions: Over 2 years after LT for various non-NAFLD indications, we identified rising BMI and rising incidence of de novo NAFLD and of significant and advanced fibrosis.

Department of Internal Medicine Comenius University Faculty of Medicine University Hospital Bratislava Ruzinov Bratislava

Department of Mathematics Faculty of Natural Sciences Matej Bel University Banska Bystrica

HEGITO FD Roosevelt Hospital Banska Bystrica

De novo tuková choroba pečene po transplantácii pečene a fibróza pečene diagnostikovaná magnetickou rezonanciou počas dvoch rokov

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