Liver transplantation for nonalcoholic fatty liver disease: new challenges and new opportunities

Abstract

Nonalcoholic fatty liver disease (NAFLD) is becoming rapidly one of the most common indications for orthotopic liver transplantation in the world. Development of graft steatosis is a significant problem during the post-transplant course, which may happen as a recurrence of pre-existing disease or de novo NAFLD. There are different risk factors that might play a role in development of graft steatosis including post-transplant metabolic syndrome, immune-suppressive medications, genetics and others. There are few studies that assessed the effects of NAFLD on graft and patient survival; most of them were limited by the duration of follow up or by the number of patients. With this review article we will try to shed light on post-liver transplantation NAFLD, significance of the disease, how it develops, risk factors, clinical course and treatment options.

Keywords: Liver cirrhosis; Liver transplantation; Metabolic syndrome; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis.

Figure 1

Development of post-transplant nonalcoholic fatty liver disease depends on a combination of host and graft factors. Schematic representation of potential mechanistic pathways that lead to development of post-transplant nonalcoholic fatty liver disease including genetic background, metabolic syndrome, insulin resistance and the effects of immunosuppressive medications. Recurrent of de novo nonalcoholic steatohepatitis (NASH) may eventually lead to the development of graft cirrhosis and the need for re-transplantation. IL28B: Interleukin 28B; PNPLA3: Patatin-like phospholipase domain-containing protein 3; DM: Diabetes mellitus; HTN: Hypertension.