Abstract
Introduction: Non-alcoholic fatty liver disease (NAFLD) is closely related to metabolic risk factors and is a highly prevalent disorder. NAFLD concept has evolved into metabolic-associated fatty liver disease (MAFLD), reflecting a more inclusive diagnostic approach related to those metabolic factors. Although the rate of liver transplantation (LT) for NAFLD/MAFLD patients has risen in Western countries, in our midst, it remains a relatively uncommon indication for LT recipients. Simultaneously, cryptogenic cirrhosis (CC) continues to be a prevalent cause of LT in our patient population. Material and methods: A cross-sectional observational study was conducted on 387 adult patients who underwent their first LT for liver cirrhosis (LC) at a Brazilian referral center between 2008 and 2018. The prevalence of clinical and histopathological characteristics of patients with CC and LC of known etiology were analyzed and compared. The diagnosis of MAFLD was reassessed according to established criteria for both groups. Results: Seventy-nine (20.4%) patients had CC, and 308 (79.6%) had LC with a defined etiology; among these, only one had NAFLD. Type 2 diabetes mellitus (T2DM) presented independent association with the CC group (32.5% vs. 21.3%; odds ratio 2.45, 95% confidence interval 1.34-4.46; p=0.003). The other characteristics showed no association with the groups. Fifteen patients (22.7%) previously diagnosed with CC were found to have MAFLD, along with 37 (15.6%), who underwent LT for cirrhosis with a defined etiology. Conclusion: NAFLD/MAFLD were frequent in patients undergoing LT in both groups, and T2DM was more prevalent in the CC group. These findings suggest that NAFLD is probably an unidentified etiology in patients with CC.