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Liver Transplantation and NAFLD/NASH

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Non-Alcoholic Fatty Liver Disease

Abstract

Due to the global epidemic of overweight and obesity, nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) have become increasingly common indications for liver transplantation (LT), both for end-stage liver disease and for hepatocellular carcinoma. NASH patients who are candidates to LT present peculiar issues as they are frequently overweight and have features of metabolic syndrome with associated comorbidities. Thus, pre-LT assessment and selection, as well as management of overweight and comorbidities, are of paramount importance to achieve good post-LT outcomes. However, despite increased postoperative morbidity and higher mortality due to cardiovascular events, long-term survival after LT in NASH patients is comparable to that for other indications. NAFLD and NASH frequently recur after LT, but this is rarely associated with progression toward cirrhosis and end-stage liver disease.

On the other hand, obesity and NAFLD in the general population have also implications for organ procurement as donor liver steatosis is associated with a higher rate of post-LT graft dysfunction and biliary complications. Whereas severely steatotic grafts are generally discarded, the classical approach to cope with mild and moderate graft steatosis has been to minimize other risk factors by limiting ischemia time and allocating these grafts to low-risk recipients. Nowadays, a lot of work is being done to reduce ischemia-reperfusion injury and to assess graft function before LT by means of various machine perfusion techniques. Whether machine perfusion will allow safer utilization of fatty liver grafts has yet to be determined.

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Authors and Affiliations

  1. General Surgery 2U—Liver Transplantation Center, A. O. U. Città della Salute e della Scienza di Torino—University of Turin, Turin, Italy

    Damiano Patrono & Renato Romagnoli

  2. Gastrohepatology Unit, A. O. U. Città della Salute e della Scienza di Torino—University of Turin, Turin, Italy

    Silvia Martini

Authors
  1. Damiano Patrono
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  2. Silvia Martini
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  3. Renato Romagnoli
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Corresponding author

Correspondence to Renato Romagnoli .

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Editors and Affiliations

  1. Department of Medical Sciences, Division of Gastroentrology and Hepatology, University of Turin, Turin, Italy

    Elisabetta Bugianesi

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Patrono, D., Martini, S., Romagnoli, R. (2020). Liver Transplantation and NAFLD/NASH. In: Bugianesi, E. (eds) Non-Alcoholic Fatty Liver Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-95828-6_19

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  • DOI: https://doi.org/10.1007/978-3-319-95828-6_19

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