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Digestive Disease Interventions 2020; 04(01): 019-030
DOI: 10.1055/s-0040-1705103
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Multidisciplinary Approach for Liver Transplantation in Patients with Nonalcoholic Steatohepatitis: It Takes a Village

Eugenia Tsai   *
1   Texas Liver Institute, University of Texas Health San Antonio, San Antonio, Texas
2   Liver Transplantation Center, University of Texas Health San Antonio, San Antonio, Texas
,
Ronit Patnaik   *
2   Liver Transplantation Center, University of Texas Health San Antonio, San Antonio, Texas
,
Naim Alkhouri
1   Texas Liver Institute, University of Texas Health San Antonio, San Antonio, Texas
2   Liver Transplantation Center, University of Texas Health San Antonio, San Antonio, Texas
› Author Affiliations
Further Information

Publication History

11 October 2019

05 January 2020

Publication Date:
02 March 2020 (online)

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Abstract

Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease in Western countries, and its aggressive form, nonalcoholic steatohepatitis (NASH), is a leading cause of cirrhosis and end-stage liver disease. The total number of new liver transplantation waitlist registrants with NASH continues to increase rapidly, making NASH the second most common indication for liver transplantation. Compared with recipients for other etiologies, patients with NASH often have higher rates of obesity, diabetes, dyslipidemia, hypertension, kidney disease, and cardiac disease. Many of these medical comorbidities are independently associated with increased preoperative risk and both short- and long-term complications. The presence of these particular risk factors necessitates the need for early detection, medical optimization, and careful preoperative care. Bariatric surgery is an effective strategy for weight loss and ultimately reducing obesity-related medical complications. In select patients, bariatric surgery—before, during, or after liver transplantation—may be useful to help improve posttransplant outcomes. NAFLD/NASH can present after liver transplantation and occurs as either recurrent or de novo disease. Posttransplant NAFLD occurs in the setting of metabolic syndrome, immunosuppression use, and genetic determinants. Future studies and efforts should focus on optimizing medical management strategies to further improve transplant outcomes in patients with NAFLD.

Keywords

nonalcoholic fatty liver disease - nonalcoholic steatohepatitis - metabolic syndrome - liver transplant - recurrent NAFLD - de novo NAFLD

Disclosure

Naim Alkhouri is on the speaker bureau for Intercept and he served as a consultant for Intercept, Allergan, and Zydus.


* First co-authors.