Non-Alcoholic Fatty Liver Disease After Liver Transplantation: A Case of Nurture and Nature

Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease. Most patients with cryptogenic cirrhosis are considered to have had burned out NAFLD. Although the recurrence and progression of NAFLD after liver transplantation (LT) have been shown previously, the incidence of de novo NAFLD after LT has not been extensively reported. In this issue of the American Journal of Gastroenterology, Dumortier et al. report the incidence of de novo post-LT NAFLD. Although most of the risk factors for post-LT NAFLD are similar to those for primary NAFLD, hepatic steatosis in the donor livers and a pre-transplant diagnosis of alcoholic liver disease remain independent risk factors. Although there are some limitations, this study provides the largest cohort of patients for whom post-LT NAFLD is reported.