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World J Transplant. Mar 18, 2021; 11(3): 37-53
Published online Mar 18, 2021. doi: 10.5500/wjt.v11.i3.37
Noninvasive markers of liver steatosis and fibrosis after liver transplantation – Where do we stand?
Ivana Mikolasevic, Sanja Stojsavljevic, Filip Blazic, Maja Mijic, Delfa Radic-Kristo, Toni Juric, Nadija Skenderevic, Mia Klapan, Andjela Lukic, Tajana Filipec Kanizaj
Ivana Mikolasevic, Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia; Department of Gastroenterology, Clinical hospital Merkur, Zagreb, Croatia; Faculty of Medicine, University of Rijeka, Rijeka, Croatia
Sanja Stojsavljevic, Department of Gastroenterology, University Hospital Center “Sestre Milosrdnice”, Zagreb 10000, Croatia
Filip Blazic, Department of Gastroenterology, University Hospital Center Rijeka, Rijeka 51000, Croatia
Maja Mijic, Nadija Skenderevic, Department of Gastroenterology, University Hospital Merkur, Zagreb 10000, Croatia
Delfa Radic-Kristo, Department of Hematology, University Hospital Merkur, Zagreb, Croatia; Faculty of Medicine, University of Zagreb, Zagreb, Croatia
Toni Juric, Mia Klapan, Andjela Lukic, School of Medicine, School of Medicine, Rijeka 51000, Croatia
Tajana Filipec Kanizaj, Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia; Faculty of Medicine, University of Zagreb, Zagreb, Croatia
Author contributions: Mikolasevic I researched the database, wrote the manuscript, and is the guarantor of this work; Stojsavljevic S, Blazic F, Mijic M, Radic-Kristo D, Juric T, Skenderevic N, Klapan M, Lukic A, Filipec Kanizaj T contributed to the discussion and reviewed/edited the manuscript.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ivana Mikolasevic, PhD, Assistant Professor, Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia; Department of Gastroenterology, Clinical hospital Merkur, Zagreb, Croatia; Faculty of Medicine, University of Rijeka, Rijeka, Croatia. ivana.mikolasevic@gmail.com
Received: July 21, 2020
Peer-review started: July 21, 2020
First decision: October 21, 2020
Revised: December 10, 2020
Accepted: March 1, 2021
Article in press: March 1, 2021
Published online: March 18, 2021
Processing time: 239 Days and 17.2 Hours
Abstract

In the last two decades, advances in immunosuppressive regimens have led to fewer complications of acute rejection crisis and consequently improved short-term graft and patient survival. In parallel with this great success, long-term post-transplantation complications have become a focus of interest of doctors engaged in transplant medicine. Metabolic syndrome (MetS) and its individual components, namely, obesity, dyslipidemia, diabetes, and hypertension, often develop in the post-transplant setting and are associated with immuno-suppressive therapy. Nonalcoholic fatty liver disease (NAFLD) is closely related to MetS and its individual components and is the liver manifestation of MetS. Therefore, it is not surprising that MetS and its individual components are associated with recurrent or “de novo” NAFLD after liver transplantation (LT). Fibrosis of the graft is one of the main determinants of overall morbidity and mortality in the post-LT period. In the assessment of post-LT steatosis and fibrosis, we have biochemical markers, imaging methods and liver biopsy. Because of the significant economic burden of post-LT steatosis and fibrosis and its potential consequences, there is an unmet need for noninvasive methods that are efficient and cost-effective. Biochemical scores can overestimate fibrosis and are not a good method for fibrosis evaluation in liver transplant recipients due to frequent post-LT thrombocytopenia. Transient elastography with controlled attenuation parameter is a promising noninvasive method for steatosis and fibrosis. In this review, we will specifically focus on the evaluation of steatosis and fibrosis in the post-LT setting in the context of de novo or recurrent NAFLD.

Keywords: Steatosis; Fibrosis; Noninvasive methods; Transient elastography; Transplantation; Nonalcoholic fatty liver disease

Core Tip: Fibrosis of the graft is one of the main determinants of overall morbidity and mortality in the post-transplantation period. In the assessment of post-transplantation steatosis and fibrosis, we have biochemical markers, imaging methods and liver biopsy. Because of the significant economic burden of post-transplantation steatosis and fibrosis and the potential consequences, there is an unmet need for noninvasive methods that are efficient and cost-effective.