Impact of Donor and Recipient Clinical Characteristics and Hepatic Histology on Steatosis/Fibrosis Following Liver Transplantation

Background Deceased donor and recipient predictors of post transplant steatosis/steatohepatitis and fibrosis are not well known. Aim Evaluate the prevalence and assess donor and recipient predictors of steatosis, steatohepatitis, and fibrosis in LT recipients. Methods Using the ITN A-WISH multicenter study (NCT00135694), donor and recipient demographic and clinical features were collected. Liver biopsies were taken from the donor liver at transplant, and from recipients per protocol and for cause (i.e. abnormal transaminases and/or to rule out rejection) and were interpreted by a central pathologist. Results 183 paired donor/recipients liver biopsies at the time of transplant and post-transplant follow up (median time 582 days; average time to last biopsies was 704 days (SD ± 402 days) were analyzed. Donor steatosis did not influence recipient steatosis or fibrosis. 10/183 recipients had steatohepatitis on the last biopsy. Recipient BMI at the time of liver biopsy was the most influential factor associated with post-transplant steatosis. Both donor and recipient metabolic syndrome features were not associated with graft steatosis. Untreated HCV infection was the most influential factor associated with the development of allograft fibrosis. Conclusions In a large experience evaluating paired donor and recipient characteristics, recipient BMI at the time of liver biopsy was most significantly associated with post-transplant steatosis. Untreated HCV etiology influenced graft fibrosis. Thus relative to untreated HCV, hepatic fibrosis in those with steatosis/steatohepatitis is less common though long term follow up is needed to determine the course of post transplant fibrosis. Emphasis on recipient weight control is essential.