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Thiazolidinedione therapy versus lifestyle recommendation in the treatment of post-liver transplant graft steatosis.

BACKGROUND
Few studies have investigated intervention therapy to reduce steatosis in the liver allograft post-transplantation.


MATERIAL AND METHODS
We compared the use of thiazolidinedione (TZD) therapy (rosiglitazone or pioglitazone) with intensified lifestyle recommendation retrospectively in 22 liver transplant patients with ≥ 10% macrovesicular steatosis on biopsies obtained ≥ 9 months post-transplant.


RESULTS
The 10 patients receiving TZD therapy and 12 receiving intensified lifestyle recommendation were comparable with respect to age, sex, disease etiology, immunosuppression regimen, and diabetes, but patients receiving TZD therapy were less overweight at start of treatment. From baseline to last biopsy, patients subject to lifestyle recommendation (mean follow-up 14 months) lost an average of 3.5 kg body weight, whereas TZD patients (mean follow-up 9 months) gained an average of 4.1 kg. Hepatic macrovesicular steatosis decreased from 63% to 31% among TZD-treated patients (p=0.005), and from 47% to 33% among those subject to lifestyle recommendation (p=0.17). Absolute and percentage change in body weight correlated with the decreased steatosis in the lifestyle group (rho=0.84 and rho=0.87, respectively, p=0.001-0.002), but not in the TZD group (rho=-0.04, p=0.92). Five patients in the TZD group stopped the medication after an average 14 months of therapy.


CONCLUSIONS
Liver graft steatosis can be reduced through weight loss or TZD treatment, but considering the risks and benefits, we advocate lifestyle recommendation as the first-line intervention.