Nonalcoholic fatty liver disease and liver transplantation - Where do we stand?

Abstract

Nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) is a challenging and multisystem disease that has a high socioeconomic impact. NAFLD/NASH is a main cause of macrovesicular steatosis and has multiple impacts on liver transplantation (LT), on patients on the waiting list for transplant, on post-transplant setting as well as on organ donors. Current data indicate new trends in the area of chronic liver disease. Due to the increased incidence of metabolic syndrome (MetS) and its components, NASH cirrhosis and hepatocellular carcinoma caused by NASH will soon become a major indication for LT. Furthermore, due to an increasing incidence of MetS and, consequently, NAFLD, there will be more steatotic donor livers and less high quality organs available for LT, in addition to a lack of available liver allografts. Patients who have NASH and are candidates for LT have multiple comorbidities and are unique LT candidates. Finally, we discuss long-term grafts and patient survival after LT, the recurrence of NASH and NASH appearing de novo after transplantation. In addition, we suggest topics and areas that require more research for improving the health care of this increasing patient population.

Keywords: Chronic liver disease; Liver transplantation; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; Outcome.

Figure 1

Higher incidence of metabolic syndrome and its complications leads to a higher incidence of nonalcoholic steatohepatitis/nonalcoholic fatty liver disease and, consequently, to more patients who have end-stage liver disease. At the same time, due to MetS and its components, we will have more steatotic livers, i.e., more organs of lower quality that are available for LT. Therefore, in the future, since NAFLD will affect both the demand for LT and the supply of available organs. Patients who have NASH and are candidates for LT have several comorbidities and are unique LT candidates. Post-LT, there are several challenging issues for NAFLD: recurrent NAFLD, de novo NAFLD and the risk for CVD and CKD. MetS: Metabolic syndrome; NAFLD: Nonalcoholic fatty liver disease; NASH: Nonalcoholic steatohepatitis; ESLD: End-stage liver disease; LT: Liver transplantation; CVD: Cardiovascular diseases; CKD: Chronic kidney disease.