Description

Galvin et al identified risk factors for nonalcoholic fatty liver disease (NAFLD) in a patient who has had a liver transplant. These can help to identify a patient who may need to be monitored more closely for the development of hepatic fibrosis and cirrhosis. The authors are from the University of Toronto.


Patient selection: liver transplant, excluding patients transplanted for nonalcoholic steatohepatitis (NASH)

 

Outcome: nonalcoholic fatty liver disease (18% had normal serum liver function tests), which occurred in a third of patients

 

Risk factors for NAFLD:

(1) elevated body mass index (BMI, range 26.3 to 34 with mean 29.4 kg per square meter; upper limit of control group 28; will use >= 29 in the implementation)

(2) diabetes mellitus

(3) weight gain after liver transplant

(4) hepatitis C virus infection

(5) immunosuppression with sirolimus

 

number of risk factors =

= SUM(number of the 5 risk factors present)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 5

• The risk of NAFLD increased with the number of risk factors present.

 

Number of Risk Factors

Percent with NAFLD

0

5.4%

1

19%

2

46%

3

74%

4

87%

5

100%

 

About 40% of patients with NAFLD had significant fibrosis (>= F2).

 

6% of patients developed cirrhosis. These patients had a serum AST > ALT, with an AST-to-ALT ratio > 1.625.


To read more or access our algorithms and calculators, please log in or register.