Spotlight paper in World Journal of Hepatology: Alshaima Al Hinai

The CDTRP would like to congratulate Alshaima Al Hinai, a graduate student from McGill University working with Dr. Giada Sebastiani for the paper “Non-alcoholic steatohepatitis in liver transplant recipients diagnosed by serum cytokeratin 18 and transient elastography: A prospective study“, recently published in World Journal of Hepatology! Our Communications Manager, Stéphanie Larivière, asked Alshaima a few questions about it:

How do you think the research will advance the field?

Although this study involves a relatively small cohort, it highlights the high incidence of nonalcoholic fatty liver disease (NAFLD) in liver transplant recipients mainly because of obesity. The results will help improve awareness and monitoring in this group. It also focuses on the importance of maintaining a normal BMI in the post-transplant period to prevent NAFLD. The study also highlights the important use of non-invasive tests to accurately diagnose NAFLD and associated liver diseases in liver recipients, prompting future studies to determine the exact role of these tests and whether they can potentially replace the current invasive liver biopsy as the gold-standard.

How did the CDTRP contribute to initiating this work?

Long term care of liver transplant recipients has been an important topic of research for our team. The CDTRP contributed to initiate and implement the regular monitoring of our liver transplant recipients with non-invasive diagnostic tests for NAFLD and liver fibrosis in clinical practice. Moreover, several subsequent research studies in liver transplant recipients have stemmed from this study.

How has the CDTRP supported the project?

The whole study has been funded by the CDTRP. This allowed two students to be first author (myself) and coauthor (Patrick Samaha) of this publication. Importantly, as a first author and a graduate student, I presented the study at the CDTRP Annual Scientific Meeting, which helped finalize the project. Furthermore, the affiliation of the study to the CDTRP encouraged patients to participate.

How could the CDTRP support the future directions of this work?

We believe that non-invasive tests may play an important role in the post liver transplant setting. The prevalence of NAFLD in Canada is rising causing a heavy burden on the healthcare system. It is also commonly seen after liver transplant because of persisting or worsening risk factors. CDTRP support could aid further research on this topic and increase awareness around NAFLD as the most frequent liver disease among Canadians.



Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) seem common after liver transplantation. AIM To investigate incidence and predictors of NAFLD and NASH by employing noninvasive testing in liver transplant recipients, namely controlled attenuation parameter (CAP) and the serum biomarker cytokeratin 18 (CK-18). We also evaluated the diagnostic accuracy of CK-18 and CAP compared to liver histology.


We prospectively recruited consecutive adult patients who received liver transplant at the McGill University Health Centre between 2015-2018. Serial measurements of CK-18 and CAP were recorded. NAFLD and NASH were diagnosed by CAP ≥ 270 dB/m, and a combination of CAP ≥ 270 dB/m with CK- 18 > 130.5 U/L, respectively. Incidences and predictors of NAFLD and NASH were investigated using survival analysis and Cox proportional hazards.


Overall, 40 liver transplant recipients (mean age 57 years; 70% males) were included. During a median follow-up of 16.8 mo (interquartile range 15.6-18.0), 63.0% and 48.5% of patients developed NAFLD and NASH, respectively. On multivariable analysis, after adjusting for sex and alanine aminotransferase, body mass index was an independent predictor of development of NAFLD [adjusted hazard ratio (aHR): 1.21, 95% confidence interval (CI): 1.04-1.41; P = 0.01] and NASH (aHR: 1.26, 95%CI: 1.06-1.49; P < 0.01). Compared to liver histology, CAP had a 76% accuracy to diagnose NAFLD, while the accuracy of CAP plus CK-18 to diagnose NASH was 82%.


NAFLD and NASH diagnosed non-invasively are frequent in liver transplant recipients within the first 18 mo. Close follow-up and nutritional counselling should be planned in overweight patients.

You can read the paper here.
About the World Journal of Hepatology

World Journal of Hepatology (WJH, World J Hepatol) is a high-quality, online, open-access, single-blind peer-reviewed journal published by the Baishideng Publishing Group. WJH accepts both solicited and unsolicited manuscripts. Articles published in WJH are high-quality, basic and clinical, influential research articles by established academic authors as well as new researchers. The paramount objective of WJH is to showcase and promote distinguished research in the field of hepatology, to help advance development of this field.