Vitamin E and Pioglitazon...

A 45-year-old woman with a BMI of 24 had a successful liver transplant for alcoholic cirrhosis using a donor liver from an obese woman with fatty liver disease. After the transplant, the patient developed ascites, hepatosplenomegaly, and elevated alkaline phosphatase levels, while AST, ALT, and bilirubin levels remained normal. Imaging showed fatty liver infiltration and compression of the hepatic veins, and a post-operative biopsy revealed severe fatty liver disease, steatohepatitis, and fibrosis. A stent was placed on improving portal venous pressure measurements, but the patient still required diuretic therapy and multiple paracenteses due to portal hypertension. Three months after the transplant, the patient's liver had grown, transaminases had increased, and another biopsy showed no improvement in steatosis or steatohepatitis despite steroid withdrawal.

Additionally, the patient had abnormally low apolipoprotein B levels and deficient HDL, LDL, and total cholesterol 12 weeks after the transplant. Levels of fat-soluble vitamins were not processed. There were no signs of a rash or other clinical manifestations of a vitamin deficiency.