Department of Pathology, San Francisco VA Health Care System, San Francisco, CA, USA.
Department of Pathology, University of California, San Francisco, CA, USA.
Diagn Pathol. 2022 Aug 10;17(1):65. doi: 10.1186/s13000-022-01247-y.
Non-alcoholic steatohepatitis (NASH) has become an increasingly recognized problem in patients after orthotopic liver transplant. The aims of this study were to compare the clinicopathologic features of recurrent and de novo NASH.
From 1995 to 2016, we performed a retrospective review of patients with a histological diagnosis of non-alcoholic steatohepatitis made more than 6 months after liver transplant at University of California, San Francisco. The cases were categorized into de novo (n = 19) or recurrent steatohepatitis (n = 37).
Hepatitis C virus (HCV) infection-related cirrhosis was the most common etiology of transplantation in de novo NASH (78% of cases, n = 29). There was no difference in glycogenosis or presence of grade 3 steatosis. More recurrent NASH biopsies had small ballooned hepatocytes (62.5% of cases) compared to de novo NASH (26.7%) (p = 0.03), and were less likely to show prominent portal inflammation (5% versus 40.5%, p = 0.0049). The diagnosis of recurrent NASH was made significantly sooner after transplantation than the diagnosis of de novo NASH (2.8 years versus 4.8 years, p = 0.02).
Overall, our results support that recurrent NASH demonstrates distinct clinicopathologic features compared to de novo NASH arising in the post-transplant setting.
非酒精性脂肪性肝炎（NASH）在肝移植后患者中已成为日益受到关注的问题。本研究旨在比较复发性和新发性 NASH 的临床病理特征。
我们对 1995 年至 2016 年期间在加利福尼亚大学旧金山分校接受肝移植后 6 个月以上组织学诊断为非酒精性脂肪性肝炎的患者进行了回顾性研究。将病例分为新发性（n = 19）或复发性脂肪性肝炎（n = 37）。
丙型肝炎病毒（HCV）感染相关肝硬化是新发性 NASH 最常见的移植病因（78%，n = 29）。糖原沉积或 3 级脂肪变性无差异。与新发性 NASH（26.7%）相比，更多的复发性 NASH 活检显示出小气球样肝细胞（62.5%）（p = 0.03），且更不可能出现明显的门脉炎症（5%与 40.5%，p = 0.0049）。与新发性 NASH 相比，复发性 NASH 的诊断在移植后更早（2.8 年与 4.8 年，p = 0.02）。
总的来说，我们的结果支持复发性 NASH 与移植后新发性 NASH 相比具有明显不同的临床病理特征。
