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Natural History NAFLD/NASH from Chronic Liver Disease Foundation

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Natural History NAFLD/NASH from Chronic Liver Disease Foundation

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Natural History NAFLD/NASH from Chronic Liver Disease Foundation

  1. 1. NAFLD/NASH: Natural History
  2. 2. Stages in the Progression of NAFLD Fatty Liver (Hepatosteatosis) Steatohepatitis Steatohepatitis with Fibrosis Cirrhosis (Decrease in Fat) Bacon BR et al. Gastroenterology. 1994;107:1103-1109. Powell EE et al. Hepatology. 1990;11:74-80. Adapted from Sanyal A. Gastroenterology. 2002;123:1705-1725.
  3. 3. Progression of NAFLD NASH NAFLD (steatosis) 10% * 5-year risk for patient with NASH Reviewed in Neuschwander-Tetri BA, Caldwell SH. Hepatology . 2003;37(5):1202-1219. Increased Fibrosis (35% * )  Cirrhosis (15% * )  Terminal Liver Failure  Hepatocellular Carcinoma
  4. 4. NASH: Natural History <ul><ul><li>Progressive fibrosis in 15-40% </li></ul></ul><ul><ul><li>Possibly responsible for most cryptogenic cirrhosis </li></ul></ul><ul><ul><li>14% of transplants due to cryptogenic cirrhosis </li></ul></ul><ul><ul><li>2% of transplants are for NASH </li></ul></ul><ul><ul><li>NASH can recur post-transplant </li></ul></ul>Matteoni CA et al. Gastroenterology. 1999;116:1413-1419. Caldwell SH et al. Hepatology. 1999;29:664-669. Ong J et al. Liver Transpl. 2001 Sep;7(9):797-801. Adapted from material provided to CLDF Slide Collection courtesy of BR Bacon.
  5. 5. Histologic Changes in 26 NAFLD Patients Followed up to Nine Years Falck-Ytter Y et al. Semin Liver Dis 2001;21:17-26, STUDY FOLLOW-UP (years) N SUBSEQUENT HISTOLOGY Improved No Change Progressed to Fibrosis Cirrhosis Lee (1989) 1.2 – 6.9 12 0/12 7/12 3/12 2/12 Powell (1990) 1 – 9 12 1/12 5/12 4/12 2/12 Bacon (1994) 4 - 7 2 0/2 1/2 0/2 1/2 Combined (%) 26 1/26 (4) 13/26 (50) 7/26 (27) 5/26 (19)
  6. 6. Histologic Changes in 26 NAFLD Patients Followed up to Nine Years NAFLD Improved 4% Fibrosis 27% No Change 50% Cirrhosis 19% Lee RG. Hum Pathol. 1989;20:594-598. Powell EE et al. Hepatology. 1990;11:74-80. Bacon BR et al. Gastroenterology. 1994;107:1103-1109. Reviewed in Falck-Ytter Y et al. Semin Liver Dis 2001;21:17-26,
  7. 7. Comparison of Outcomes* of NAFLD by Histologic Pattern * Retrospective analysis of 132 patients followed up to 18 years. † Fat alone; ‡ Fat + lobular inflammation; § Fat + ballooning; ¶ Fat + ballooning + Mallory bodies or perisinusoidal fibrosis Matteoni CA et al. Gastroenterology 1999;116:1413-1419. OUTCOME TYPE 1 † (n=49) TYPE 2 ‡ (n=10) NASH TYPE 3 § (n=19) TYPE 4 ¶ (n=54) Cirrhosis 2 (4%) 0 (0%) 4 (21%) 14 (26%) Death 16 (33%) 3 (30%) 5 (26%) 24 (44%) Liver-related Death 1 (2%) 0 (0%) 1 (5%) 7 (13%)

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