NONALCOHOLIC STEATOHEPATITIS IN POSTTRANSPLANTATION LIVER: REVIEW ARTICLE REV ASSOC MED BRAS 2018; 64(2):187-194 187 REVIEW ARTICLE Nonalcoholic steatohepatitis in posttransplantation liver: Review article ANTÔNIO RICARDO CARDIA FERRAZ DE ANDRADE 1,2 * , HELMA P . COTRIM 1 , PAULO L. BITTENCOURT 2 , CAROLINA G. ALMEIDA 1 , NEY CHRISTIAN AMARAL BOA SORTE 1 1 Medicine and Health Graduate Program, Faculdade de Medicina da Bahia da Universidade Federal da Bahia, Salvador, BA, Brazil 2 Hospital Português, Salvador, BA, Brazil SUMMARY Study conducted by the Medicine and Health Graduate Program, Faculdade de Medicina da Bahia da Universidade Federal da Bahia, Salvador, BA, Brazil Article received: 3/19/2017 Accepted for publication: 6/26/2017 *Correspondence: Address: Rua Padre Camilo Torrend, 145/402 Salvador, BA – Brasil Postal code: 40210-650 arcfa@ufba.br http://dx.doi.org/10.1590/1806-9282.64.02.187 Introduction: Nonalcoholic steatohepatitis (NASH) associated or not with cirrhosis is the third leading indication for liver transplantation (LT) around the world. After transplants, NASH has a high prevalence and occurs as both recurrent and de novo manifestations. De novo NASH can also occur in allografts of patients transplanted for non-NASH liver disease. Objective: To evaluate recurrent or de novo NASH in post-LT patients. Method: A literature review was performed using search engines of indexed scientific material, including Medline (by PubMed), Scielo and Lilacs, to identify articles published in Portuguese and English until August 2016. Eligible studies included: place and year of publication, prevalence, clinical characteristics, risk factors and survival. Results: A total of 110 articles were identified and 63 were selected. Most of the studies evaluated recurrence and survival after LT. Survival reached 90-100% in 1 year and 52-100% in 5 years. Recurrence of NAFLD (steatosis) was described in 15-100% and NASH, in 4-71%. NAFLD and de novo NASH were observed in 18-67% and 3-17%, respectively. Metabolic syndrome, diabetes mellitus, dyslipidemia and hypertension were seen in 45-58%, 18-59%, 25-66% and 52-82%, respectively. Conclusion: After liver transplants, patients present a high prevalence of recurrent and de novo NASH. They also show a high frequence of metabolic disorders. Nevertheless, these alterations seem not to influence patient survival. Keywords: Nonalcoholic Fatty Liver Disease. Liver Transplantation. Fatty Liver. Metabolic Syndrome. Diabetes Mellitus. INTRODUCTION Nonalcoholic fatty liver disease (NAFLD) affects about a third of the Western population, being the largest cause of elevation of aminotransferases in the world. 1 It is a broad spectrum pathological condition that includes steatosis, steatohepatitis (NASH), fibrosis and eventually cirrhosis (Figure 1) and hepatocellular carcinoma (HCC). 2,3 Steatosis may have a slow and asymptomatic course, but in 20% to 30% of cases it progresses to steatohepatitis, the stage of disease with the greatest potential for progres- sion to cirrhosis and HCC (Figure 1). Factors associated with the development of NASH include obesity, diabetes mellitus (DM), dyslipidemia and insulin resistance, which makes this disorder increas- ingly recognized as the hepatic component of metabolic syndrome (MetS). 4 Compared to the general population, NASH patients have increased cardiovascular risk and mortality. 5 The significant increase in morbidity and mor- tality due to the obesity epidemic caused NAFLD, espe- cially NASH combined with cirrhosis, to become the 3 rd largest cause of liver transplantation, with the estimate that it will be the leading cause in 20 years. 6,7 After transplantation, some studies have observed up to 100% recurrence of NAFLD after 5 years. 8-10 The appear- ance of NAFLD in transplanted patients due to causes other than NASH, i.e. de novo NAFLD, was first described by Poordad et al. 11 in patients undergoing transplantation on account of hepatitis C. Due to better results after he-