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.
