Nonalcoholic Fatty Liver Disease in the Post Liver Transplant Patient
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LIVER TRANSPLANTATION (D MULLIGAN AND R BATRA, SECTION EDITORS)
Nonalcoholic Fatty Liver Disease in the Post Liver Transplant Patient Jennifer Batisti 1
&
Wajahat Z. Mehal 1
Accepted: 7 October 2020 / Published online: 17 November 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review Nonalcoholic fatty liver disease (NAFLD) may occur as a de novo or recurrent disease among recipients of liver transplant (LT). We seek to review the currently available information on the diagnosis, implications, and management of NAFLD in the post LT population with a focus on the practical medical management of this disease. Recent Findings Recent studies emphasize that NAFLD is the hepatic manifestation of the metabolic syndrome, mediated largely by insulin resistance, with liver recipient factors being the primary determinants of the development of graft steatosis. Posttransplant nonalcoholic steatohepatitis (NASH) may progress to the development of graft fibrosis and cirrhosis. Risk factors such as hypertension, dyslipidemia, hyperglycemia, and excess weight gain should be addressed proactively in the post-transplant period. Summary Interventions to prevent or treat NAFLD in the patient who has undergone LT must take into account the specialized needs of the post-transplant care setting, including the management of immunosuppression, and the potential presence of high catabolic needs after surgery. Future research is needed to tailor NAFLD interventions to the post-transplant population. Keywords Nonalcoholic fatty liver disease . Post-transplant fatty liver disease . Recurrent nonalcoholic fatty liver disease . Post liver transplant nutrition . Weight loss after liver transplant . Cirrhosis and metabolic syndrome
Introduction The past decades have seen dramatic gains in post-transplant survival and an improved understanding of the long-term mortality and morbidity associated with the manifestations of the metabolic syndrome (MetS) in the post-transplant patient [1]. Nonalcoholic fatty liver disease (NAFLD) and its inflammatory component nonalcoholic steatohepatitis (NASH) may occur in the post-transplant patient. NAFLD is defined as the presence of ≥ 5% of hepatic steatosis without evidence of hepatocellular injury, in the absence of a secondary cause of hepatic fat accumulation [2]. NASH is defined as the presence of ≥ 5% of hepatic steatosis accompanied by inflammation and hepatocyte injury, with or without fibrosis [2]. NAFLD is now recognized as the hepatic manifestation of MetS [3], and it is understood that NAFLD and NASH exist on a specThis article is part of the Topical collection on Liver Transplantation * Jennifer Batisti [email protected] 1
Yale University School of Medicine, New Haven, CT, USA
trum of disease, ranging from asymptomatic steatosis to steatohepatitis and decompensated cirrhosis. Importantly, NAFLD is also associated with the early development of cancers, primarily hepatocellular carcinoma (HCC), even in patients without cirrhosis [4, 5•]. It has become clear that NAFLD is a
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