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Review
. 2020 Jun 28;8(2):215-221.
doi: 10.14218/JCTH.2020.00014. Epub 2020 May 29.

NAFLD Epidemiology, Emerging Pharmacotherapy, Liver Transplantation Implications and the Trends in the United States

Chiranjeevi Gadiparthi  1 , Moshe Spatz  2 , Simi Greenberg  3 , Umair Iqbal  4 , Sowjanya Kanna  5 , Sanjaya K Satapathy  6 , Arkady Broder  1 , Aijaz Ahmed  7
Affiliations
Review

NAFLD Epidemiology, Emerging Pharmacotherapy, Liver Transplantation Implications and the Trends in the United States

Chiranjeevi Gadiparthi et al. J Clin Transl Hepatol. .

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic syndrome. The spread of obesity worldwide in pandemic proportions has led to a rapid rise of NAFLD in developed and developing countries alike. There are no approved pharmacological agents to treat steatohepatitis or advanced fibrosis but obeticholic acid recently has shown some promise in phase III trial. Currently, NAFLD is the number one etiology for simultaneous liver and kidney transplantation in the USA, second most common indication for liver transplantation (LT) and projected to become number one very soon. LT for NAFLD poses unique challenges, as these patients are generally older, obese and more likely to have a number of metabolic risk factors. Bariatric surgery is an option and can be considered if a structured weight loss program does not achieve the sustained weight loss goal. Comprehensive cardiovascular risk assessment and aggressive management of comorbid conditions are crucial in the LT evaluation process to improve post-transplant survival. Recurrent nonalcoholic steatohepatitis after LT is not uncommon, and thus warrants primary and secondary prevention strategies through a multidisciplinary approach. Prevalence of NAFLD in a donor population is a unique and growing concern that limits the access to quality liver grafts.

Keywords: Liver transplantation; NAFL; NAFLD; NASH.

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Conflict of interest statement

The authors have no conflict of interests related to this publication.

Figures

Fig. 1.
Fig. 1.. Natural history of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis and recurrence after liver transplantation.
Fig. 2.
Fig. 2.. Temporal trends in annual waitlist additions for top 5 etiologies in the USA UNOS 2008-2018.
Abbreviations: ALD, alcoholic liver disease; CC, cryptogenic cirrhosis; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis; UNOS, United Network for Organ Sharing.
Fig. 3.
Fig. 3.. Temporal trends of annual liver transplantations for top 5 etiologies in the USA UNOS 2008-2018.
Abbreviations: ALD, alcoholic liver disease; CC, cryptogenic cirrhosis; HCV, hepatitis C virus; NASH, nonalcoholic steatohepatitis; UNOS, United Network for Organ Sharing.
See this image and copyright information in PMC

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