In the Journals

Hepatic steatosis resolves in most post-transplant pediatric patients

Hepatic steatosis typically develops in pediatric patients after liver transplantation, but resolves in most cases, according to results of a recently published study.

“Hepatic steatosis was common within the first months posttransplant, but not in the long-term, in our cohort of pediatric liver transplant recipients. The majority of steatosis detected was mild, seen in conjunction with other forms of liver damage, and subsequently resolved. A small minority of patients had biopsies that met criteria for NASH; all had elevated serum transaminases leading to for-cause biopsies,” the researchers wrote.

The researchers conducted a retrospective review of 84 pediatric patients who had undergone liver transplantation between January 1988 and June 2015. Initial biopsies were performed on the patients posttransplant.

Fifty patients had steatosis in one biopsy, 23 had steatosis in two biopsies, seven patients had steatosis in three biopsies and four patients had steatosis in four or more biopsies.

Steatosis resolution occurred in 87% of the group of 50 patients, 69% of the group of 23 patients and 71% of the group of seven patients. Among the four patients with four or more biopsies showing steatosis, two patients had improved but unresolved steatosis at follow-up biopsy; one resolved after corticosteroid treatment, but later had recurrence; and one had progressive familial intrahepatic cholestasis type 1.

Of the biopsies with steatosis, 90% had no features suggestive of nonalcoholic steatohepatitis. Seven patients met criteria for NASH or borderline NASH. Among four biopsies that met criteria for NASH, each had ballooned hepatocytes and at least grade 2 steatosis. Among five biopsies that met criteria for borderline NASH, three had steatosis with hepatocellular ballooning and all five had features of other types of liver damage.

Seventy patients had surveillance biopsy results available for analysis. One surveillance biopsy had significant steatosis of grade 1 and four patients had surveillance biopsies with very mild steatosis. The researchers found no correlation between fibrosis on surveillance biopsy and steatosis on preceding biopsies and perivenular fibrosis had no association with steatosis on previous biopsies.

“Although we suspect that factors like preservation injury, posttransplant corticosteroids and nutritional supplementation contributed to early steatosis, we could not define the exact contribution of each in this retrospective study,” the researchers wrote. “Further research is needed on risk factors for and outcomes associated with persistent hepatic steatosis and NASH in pediatric liver transplant recipients. As knowledge from long-term monitoring and surveillance biopsies builds, we will gain more insight into the clinical importance of these conditions in pediatric patients.” – by Talitha Bennett

Disclosures: The researchers report no relevant financial disclosures.

Hepatic steatosis typically develops in pediatric patients after liver transplantation, but resolves in most cases, according to results of a recently published study.

“Hepatic steatosis was common within the first months posttransplant, but not in the long-term, in our cohort of pediatric liver transplant recipients. The majority of steatosis detected was mild, seen in conjunction with other forms of liver damage, and subsequently resolved. A small minority of patients had biopsies that met criteria for NASH; all had elevated serum transaminases leading to for-cause biopsies,” the researchers wrote.

The researchers conducted a retrospective review of 84 pediatric patients who had undergone liver transplantation between January 1988 and June 2015. Initial biopsies were performed on the patients posttransplant.

Fifty patients had steatosis in one biopsy, 23 had steatosis in two biopsies, seven patients had steatosis in three biopsies and four patients had steatosis in four or more biopsies.

Steatosis resolution occurred in 87% of the group of 50 patients, 69% of the group of 23 patients and 71% of the group of seven patients. Among the four patients with four or more biopsies showing steatosis, two patients had improved but unresolved steatosis at follow-up biopsy; one resolved after corticosteroid treatment, but later had recurrence; and one had progressive familial intrahepatic cholestasis type 1.

Of the biopsies with steatosis, 90% had no features suggestive of nonalcoholic steatohepatitis. Seven patients met criteria for NASH or borderline NASH. Among four biopsies that met criteria for NASH, each had ballooned hepatocytes and at least grade 2 steatosis. Among five biopsies that met criteria for borderline NASH, three had steatosis with hepatocellular ballooning and all five had features of other types of liver damage.

Seventy patients had surveillance biopsy results available for analysis. One surveillance biopsy had significant steatosis of grade 1 and four patients had surveillance biopsies with very mild steatosis. The researchers found no correlation between fibrosis on surveillance biopsy and steatosis on preceding biopsies and perivenular fibrosis had no association with steatosis on previous biopsies.

“Although we suspect that factors like preservation injury, posttransplant corticosteroids and nutritional supplementation contributed to early steatosis, we could not define the exact contribution of each in this retrospective study,” the researchers wrote. “Further research is needed on risk factors for and outcomes associated with persistent hepatic steatosis and NASH in pediatric liver transplant recipients. As knowledge from long-term monitoring and surveillance biopsies builds, we will gain more insight into the clinical importance of these conditions in pediatric patients.” – by Talitha Bennett

Disclosures: The researchers report no relevant financial disclosures.