Skip to main content

Advertisement

Log in

Recurrent NASH Post-liver Transplant: Implications and Treatment

  • Fatty Liver Disease (D Halegoua-De Marzio, Section Editor)
  • Published:
Current Hepatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

With obesity prevalence increasing, nonalcoholic steatohepatitis (NASH) is the fastest growing indication for liver transplantation (LT). It is a common phenomenon to observe recurrence of NASH in post-LT patients. This review discusses about the prevalence of NASH and summarizes the diagnosis and management of recurrent and de novo NASH in post-LT patients.

Recent Findings.

Due to the increased incidence of recurrent and de novo NASH in post-LT patients, it is important to prevent and control metabolic risk factors such as diabetes mellitus, hypertension, and obesity.

Summary

Tailored immunosuppression along with controlling metabolic parameters and weight gain remain the cornerstone of management. Extrapolation of usage of pre-transplant NASH pharmacotherapy in post-LT patients with recurrent or de novo NASH will remain a challenge for the future until further studies are available.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Younossi Z, Tacke F, Arrese M, Chander Sharma B, Mostafa I, Bugianesi E, et al. Global perspectives on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Hepatology. 2019;69(6):2672–82. https://doi.org/10.1002/hep.30251.

    Article  PubMed  Google Scholar 

  2. Kim WR, Lake JR, Smith JM, Skeans MA, Schladt DP, Edwards EB, et al. OPTN/SRTR 2015 annual data report: liver. Am J Transplant. 2017;17(Suppl 1):174–251. https://doi.org/10.1111/ajt.14126.

    Article  PubMed  Google Scholar 

  3. Goldberg D, Ditah IC, Saeian K, Lalehzari M, Aronsohn A, Gorospe EC, et al. Changes in the prevalence of hepatitis C virus infection, nonalcoholic steatohepatitis, and alcoholic liver disease among patients with cirrhosis or liver failure on the waitlist for liver transplantation. Gastroenterology. 2017;152(5):1090–9el. https://doi.org/10.1053/j.gastro.2017.01.003.

    Article  PubMed  Google Scholar 

  4. Wong RJ, Aguilar M, Cheung R, Perumpail RB, Harrison SA, Younossi ZM, et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;148(3):547–55. https://doi.org/10.1053/j.gastro.2014.11.039.

    Article  PubMed  Google Scholar 

  5. Younossi ZM, Stepanova M, Ong J, Trimble G, AlQahtani S, Younossi I et al. Nonalcoholic steatohepatitis is the most rapidly increasing indication for liver transplantation in the United States. Clin Gastroenterol Hepatol. 2021;19(3):580–9 e5. doi:https://doi.org/10.1016/j.cgh.2020.05.064. Important review of the increasing incidence of NASH as an indication for transplant.

  6. Jinjuvadia R, Antaki F, Lohia P, Liangpunsakul S. The association between nonalcoholic fatty liver disease and metabolic abnormalities in the United States population. J Clin Gastroenterol. 2017;51(2):160–6. https://doi.org/10.1097/MCG.0000000000000666.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Bellentani S. The epidemiology of non-alcoholic fatty liver disease. Liver Int. 2017;37(Suppl 1):81–4. https://doi.org/10.1111/liv.13299.

    Article  PubMed  Google Scholar 

  8. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73–84. https://doi.org/10.1002/hep.28431.

    Article  PubMed  Google Scholar 

  9. Younossi ZM, Loomba R, Anstee QM, Rinella ME, Bugianesi E, Marchesini G, et al. Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis. Hepatology. 2018;68(1):349–60. https://doi.org/10.1002/hep.29721.

    Article  PubMed  Google Scholar 

  10. Younossi ZM, Loomba R, Rinella ME, Bugianesi E, Marchesini G, Neuschwander-Tetri BA, et al. Current and future therapeutic regimens for nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Hepatology. 2018;68(1):361–71. https://doi.org/10.1002/hep.29724.

    Article  PubMed  Google Scholar 

  11. Younossi Z, Anstee QM, Marietti M, Hardy T, Henry L, Eslam M, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2018;15(1):11–20. https://doi.org/10.1038/nrgastro.2017.109.

    Article  PubMed  Google Scholar 

  12. Day CP, James OF. Steatohepatitis: a tale of two “hits”? Gastroenterology. 1998;114(4):842–5. https://doi.org/10.1016/s0016-5085(98)70599-2.

    Article  CAS  PubMed  Google Scholar 

  13. Harrison SA, Fecht W, Brunt EM, Neuschwander-Tetri BA. Orlistat for overweight subjects with nonalcoholic steatohepatitis: a randomized, prospective trial. Hepatology. 2009;49(1):80–6. https://doi.org/10.1002/hep.22575.

    Article  CAS  PubMed  Google Scholar 

  14. Promrat K, Kleiner DE, Niemeier HM, Jackvony E, Kearns M, Wands JR, et al. Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. Hepatology. 2010;51(1):121–9. https://doi.org/10.1002/hep.23276.

    Article  CAS  PubMed  Google Scholar 

  15. Vilar-Gomez E M-PY, Calzadilla-Bertot L. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015 149 2 367 78. https://doi.org/10.1053/j.gastro.2015.04.005.

  16. Dajani A, AbuHammour A. Treatment of nonalcoholic fatty liver disease: where do we stand? An overview Saudi J Gastroenterol. 2016;22(2):91–105. https://doi.org/10.4103/1319-3767.178527.

    Article  PubMed  Google Scholar 

  17. Ramai D, Tai W, Rivera M, Facciorusso A, Tartaglia N, Pacilli M et al. Natural progression of non-alcoholic steatohepatitis to hepatocellular carcinoma. Biomedicines. 2021;9(2). https://doi.org/10.3390/biomedicines9020184.

  18. Lanthier N. Targeting Kupffer cells in non-alcoholic fatty liver disease/non-alcoholic steatohepatitis: why and how? World J Hepatol. 2015;7(19):2184–8. https://doi.org/10.4254/wjh.v7.i19.2184.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Chettouh H, Lequoy M, Fartoux L, Vigouroux C, Desbois-Mouthon C. Hyperinsulinaemia and insulin signalling in the pathogenesis and the clinical course of hepatocellular carcinoma. Liver Int. 2015;35(10):2203–17. https://doi.org/10.1111/liv.12903.

    Article  CAS  PubMed  Google Scholar 

  20. Younossi ZM, Marchesini G, Pinto-Cortez H, Petta S. Epidemiology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: implications for liver transplantation. Transplantation. 2019;103(1):22–7. https://doi.org/10.1097/TP.0000000000002484.

    Article  PubMed  Google Scholar 

  21. Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328–57. https://doi.org/10.1002/hep.29367.

    Article  PubMed  Google Scholar 

  22. Younossi ZM, Ratziu V, Loomba R, Rinella M, Anstee QM, Goodman Z, et al. Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial. Lancet. 2019;394(10215):2184–96. https://doi.org/10.1016/S0140-6736(19)33041-7.

    Article  CAS  PubMed  Google Scholar 

  23. Vargas JIAM, Shah VH, Arab JP. Use of statins in patients with chronic liver disease and cirrhosis: current views and prospects. Curr Gastroenterol Rep. 2017;19(9):43. https://doi.org/10.1007/s11894-017-0584-7.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Gadiparthi C, Spatz M, Greenberg S, Iqbal U, Kanna S, Satapathy SK, et al. NAFLD epidemiology, emerging pharmacotherapy, liver transplantation implications and the trends in the United States. J Clin Transl Hepatol. 2020;8(2):215–21. https://doi.org/10.14218/JCTH.2020.00014.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Zamora-Valdes D, Watt KD, Kellogg TA, Poterucha JJ, Di Cecco SR, Francisco-Ziller NM, et al. Long-term outcomes of patients undergoing simultaneous liver transplantation and sleeve gastrectomy. Hepatology. 2018;68(2):485–95. https://doi.org/10.1002/hep.29848.

    Article  CAS  PubMed  Google Scholar 

  26. Saab S, Lalezari D, Pruthi P, Alper T, Tong MJ. The impact of obesity on patient survival in liver transplant recipients: a meta-analysis. Liver Int. 2015;35(1):164–70. https://doi.org/10.1111/liv.12431.

    Article  PubMed  Google Scholar 

  27. Sourianarayanane A, Arikapudi S, McCullough AJ, Humar A. Nonalcoholic steatohepatitis recurrence and rate of fibrosis progression following liver transplantation. Eur J Gastroenterol Hepatol. 2017;29(4):481–7. https://doi.org/10.1097/MEG.0000000000000820.

    Article  PubMed  Google Scholar 

  28. Tokodai K, Karadagi A, Kjaernet F, Romano A, Ericzon BG, Nowak G. Characteristics and risk factors for recurrence of nonalcoholic steatohepatitis following liver transplantation. Scand J Gastroenterol. 2019;54(2):233–9. https://doi.org/10.1080/00365521.2019.1577484.

    Article  CAS  PubMed  Google Scholar 

  29. Kakar S, Dugum M, Cabello R, Humar A, Ahmad J, Malik SM. Incidence of recurrent NASH-related allograft cirrhosis. Dig Dis Sci. 2019;64(5):1356–63. https://doi.org/10.1007/s10620-018-5413-9.

    Article  PubMed  Google Scholar 

  30. Bhati C, Idowu MO, Sanyal AJ, Rivera M, Driscoll C, Stravitz RT, et al. Long-term outcomes in patients undergoing liver transplantation for nonalcoholic steatohepatitis-related cirrhosis. Transplantation. 2017;101(8):1867–74. https://doi.org/10.1097/TP.0000000000001709.

    Article  PubMed  Google Scholar 

  31. Losurdo G, Castellaneta A, Rendina M, Carparelli S, Leandro G, Di Leo A. Systematic review with meta-analysis: de novo non-alcoholic fatty liver disease in liver-transplanted patients. Aliment Pharmacol Ther. 2018;47(6):704–14. https://doi.org/10.1111/apt.14521.

    Article  CAS  PubMed  Google Scholar 

  32. Saeed N, Glass L, Sharma P, Shannon C, Sonnenday CJ, Tincopa MA. Incidence and risks for nonalcoholic fatty liver disease and steatohepatitis post-liver transplant: systematic review and meta-analysis. Transplantation. 2019;103(11):e345–54. https://doi.org/10.1097/TP.0000000000002916.

    Article  CAS  PubMed  Google Scholar 

  33. Merola J, Liapakis A, Mulligan DC, Yoo PS. Non-alcoholic fatty liver disease following liver transplantation: a clinical review. Clin Transplant. 2015;29(9):728–37. https://doi.org/10.1111/ctr.12585.

    Article  PubMed  Google Scholar 

  34. Fazel Y, Koenig AB, Sayiner M, Goodman ZD, Younossi ZM. Epidemiology and natural history of non-alcoholic fatty liver disease. Metabolism. 2016;65(8):1017–25. https://doi.org/10.1016/j.metabol.2016.01.012.

    Article  CAS  PubMed  Google Scholar 

  35. McPherson S, Hardy T, Henderson E, Burt AD, Day CP, Anstee QM. Evidence of NAFLD progression from steatosis to fibrosing-steatohepatitis using paired biopsies: implications for prognosis and clinical management. J Hepatol. 2015;62(5):1148–55. https://doi.org/10.1016/j.jhep.2014.11.034.

    Article  PubMed  Google Scholar 

  36. Watt KD, Charlton MR. Metabolic syndrome and liver transplantation: a review and guide to management. J Hepatol. 2010;53(1):199–206. https://doi.org/10.1016/j.jhep.2010.01.040.

    Article  PubMed  Google Scholar 

  37. Sprinzl MF, Weinmann A, Lohse N, Tonissen H, Koch S, Schattenberg J, et al. Metabolic syndrome and its association with fatty liver disease after orthotopic liver transplantation. Transpl Int. 2013;26(1):67–74. https://doi.org/10.1111/j.1432-2277.2012.01576.x.

    Article  CAS  PubMed  Google Scholar 

  38. Li DW, Lu TF, Hua XW, Dai HJ, Cui XL, Zhang JJ, et al. Risk factors for new onset diabetes mellitus after liver transplantation: a meta-analysis. World J Gastroenterol. 2015;21(20):6329–40. https://doi.org/10.3748/wjg.v21.i20.6329.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Iadevaia M, Giusto M, Giannelli V, Lai Q, Rossi M, Berloco P, et al. Metabolic syndrome and cardiovascular risk after liver transplantation: a single-center experience. Transplant Proc. 2012;44(7):2005–6. https://doi.org/10.1016/j.transproceed.2012.06.022.

    Article  CAS  PubMed  Google Scholar 

  40. Manzarbeitia C, Reich DJ, Rothstein KD, Braitman LE, Levin S, Munoz SJ. Tacrolimus conversion improves hyperlipidemic states in stable liver transplant recipients. Liver Transpl. 2001;7(2):93–9. https://doi.org/10.1053/jlts.2001.21289.

    Article  CAS  PubMed  Google Scholar 

  41. Zimmermann A, Zobeley C, Weber MM, Lang H, Galle PR, Zimmermann T. Changes in lipid and carbohydrate metabolism under mTOR- and calcineurin-based immunosuppressive regimen in adult patients after liver transplantation. Eur J Intern Med. 2016;29:104–9. https://doi.org/10.1016/j.ejim.2015.12.022.

    Article  CAS  PubMed  Google Scholar 

  42. Petta S, Ciresi A, Bianco J, Geraci V, Boemi R, Galvano L, et al. Insulin resistance and hyperandrogenism drive steatosis and fibrosis risk in young females with PCOS. PLoS ONE. 2017;12(11):e0186136. https://doi.org/10.1371/journal.pone.0186136.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Finkenstedt A, Auer C, Glodny B, Posch U, Steitzer H, Lanzer G, et al. Patatin-like phospholipase domain-containing protein 3 rs738409-G in recipients of liver transplants is a risk factor for graft steatosis. Clin Gastroenterol Hepatol. 2013;11(12):1667–72. https://doi.org/10.1016/j.cgh.2013.06.025.

    Article  CAS  PubMed  Google Scholar 

  44. Watt KD, Dierkhising R, Fan C, Heimbach JK, Tillman H, Goldstein D, et al. Investigation of PNPLA3 and IL28B genotypes on diabetes and obesity after liver transplantation: insight into mechanisms of disease. Am J Transplant. 2013;13(9):2450–7. https://doi.org/10.1111/ajt.12355.

    Article  CAS  PubMed  Google Scholar 

  45. Ling Q, Xu X, Wang K, Wang C, Xiang P, Zhang X, et al. Donor PPARalpha gene polymorphisms influence the susceptibility to glucose and lipid disorders in liver transplant recipients: a strobe-compliant observational study. Medicine (Baltimore). 2015;94(35):e1421. https://doi.org/10.1097/MD.0000000000001421.

    Article  CAS  Google Scholar 

  46. Crespo G, Castro-Narro G, Garcia-Juarez I, Benitez C, Ruiz P, Sastre L, et al. Usefulness of liver stiffness measurement during acute cellular rejection in liver transplantation. Liver Transpl. 2016;22(3):298–304. https://doi.org/10.1002/lt.24376.

    Article  PubMed  Google Scholar 

  47. Bazerbachi F, Haffar S, Wang Z, Cabezas J, Arias-Loste MT, Crespo J, et al. Range of normal liver stiffness and factors associated with increased stiffness measurements in apparently healthy individuals. Clin Gastroenterol Hepatol. 2019;17(1):54–64el. https://doi.org/10.1016/j.cgh.2018.08.069.

    Article  PubMed  Google Scholar 

  48. van Werven JR, Marsman HA, Nederveen AJ, Smits NJ, ten Kate FJ, van Gulik TM, et al. Assessment of hepatic steatosis in patients undergoing liver resection: comparison of US, CT, T1-weighted dual-echo MR imaging, and point-resolved 1H MR spectroscopy. Radiology. 2010;256(1):159–68. https://doi.org/10.1148/radiol.10091790.

    Article  PubMed  Google Scholar 

  49. Hepburn MJ, Vos JA, Fillman EP, Lawitz EJ. The accuracy of the report of hepatic steatosis on ultrasonography in patients infected with hepatitis C in a clinical setting: a retrospective observational study. BMC Gastroenterol. 2005;5:14. https://doi.org/10.1186/1471-230X-5-14.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Hashemi SA, Alavian SM, Gholami-Fesharaki M. Assessment of transient elastography (FibroScan) for diagnosis of fibrosis in non-alcoholic fatty liver disease: a systematic review and meta-analysis. Caspian J Intern Med. 2016;7(4):242–52.

    PubMed  PubMed Central  Google Scholar 

  51. Patil DT, Yerian LM. Evolution of nonalcoholic fatty liver disease recurrence after liver transplantation. Liver Transpl. 2012;18(10):1147–53. https://doi.org/10.1002/lt.23499.

    Article  PubMed  Google Scholar 

  52. Lin YH, Yeh ML, Huang CI, Yang JF, Liang PC, Huang CF, et al. The performance of acoustic radiation force impulse imaging in predicting liver fibrosis in chronic liver diseases. Kaohsiung J Med Sci. 2016;32(7):362–6. https://doi.org/10.1016/j.kjms.2016.05.008.

    Article  PubMed  Google Scholar 

  53. Kim D, Kim WR, Talwalkar JA, Kim HJ, Ehman RL. Advanced fibrosis in nonalcoholic fatty liver disease: noninvasive assessment with MR elastography. Radiology. 2013;268(2):411–9. https://doi.org/10.1148/radiol.13121193.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Loomba R, Wolfson T, Ang B, Hooker J, Behling C, Peterson M, et al. Magnetic resonance elastography predicts advanced fibrosis in patients with nonalcoholic fatty liver disease: a prospective study. Hepatology. 2014;60(6):1920–8. https://doi.org/10.1002/hep.27362.

    Article  CAS  PubMed  Google Scholar 

  55. Cui J, Ang B, Haufe W, Hernandez C, Verna EC, Sirlin CB, et al. Comparative diagnostic accuracy of magnetic resonance elastography vs. eight clinical prediction rules for non-invasive diagnosis of advanced fibrosis in biopsy-proven non-alcoholic fatty liver disease: a prospective study. Aliment Pharmacol Ther. 2015;41(12):1271–80. https://doi.org/10.1111/apt.13196.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Tan CH, Venkatesh SK. Magnetic resonance elastography and other magnetic resonance imaging techniques in chronic liver disease: current status and future directions. Gut Liver. 2016;10(5):672–86. https://doi.org/10.5009/gnl15492.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Lee VS, Miller FH, Omary RA, Wang Y, Ganger DR, Wang E, et al. Magnetic resonance elastography and biomarkers to assess fibrosis from recurrent hepatitis C in liver transplant recipients. Transplantation. 2011;92(5):581–6. https://doi.org/10.1097/TP.0b013e31822805fa.

    Article  PubMed  Google Scholar 

  58. Cui J, Heba E, Hernandez C, Haufe W, Hooker J, Andre MP, et al. Magnetic resonance elastography is superior to acoustic radiation force impulse for the diagnosis of fibrosis in patients with biopsy-proven nonalcoholic fatty liver disease: a prospective study. Hepatology. 2016;63(2):453–61. https://doi.org/10.1002/hep.28337.

    Article  PubMed  Google Scholar 

  59. Taneja S, Roy A. Nonalcoholic steatohepatitis recurrence after liver transplant. Transl Gastroenterol Hepatol. 2020;5:24. https://doi.org/10.21037/tgh.2019.10.12.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Narayanan P, Mara K, Izzy M, Dierkhising R, Heimbach J, Allen AM, et al. Recurrent or de novo allograft steatosis and long-term outcomes after liver transplantation. Transplantation. 2019;103(1):e14–21. https://doi.org/10.1097/TP.0000000000002317. (A retrospective review that focuses on determining the frequency and impact of allograft steatosis on long-term post-transplant outcomes.)

    Article  PubMed  Google Scholar 

  61. Kennedy C, Redden D, Gray S, Eckhoff D, Massoud O, McGuire B, et al. Equivalent survival following liver transplantation in patients with non-alcoholic steatohepatitis compared with patients with other liver diseases. HPB (Oxford). 2012;14(9):625–34. https://doi.org/10.1111/j.1477-2574.2012.00497.x.

    Article  Google Scholar 

  62. Thuluvath AJ, Chen PH, Thuluvath PJ, Kantsevoy S, Savva Y. Poor survival after retransplantation in NASH cirrhosis. Transplantation. 2019;103(1):101–8. https://doi.org/10.1097/TP.0000000000002135. (Important review comparing the post-LT survival rates for NASH versus other common indications for LT.)

    Article  PubMed  Google Scholar 

  63. Cotter TG, Charlton M. Nonalcoholic steatohepatitis after liver transplantation. Liver Transpl. 2020;26(1):141–59. https://doi.org/10.1002/lt.25657. (An important review on management of metabolic comorbidities, immunosuppression, the role of bariatric surgery, nutritional and pharmacotherapy of NASH in post-LT patients.)

    Article  PubMed  Google Scholar 

  64. Musso G, Gambino R, Cassader M, Pagano G. A meta-analysis of randomized trials for the treatment of nonalcoholic fatty liver disease. Hepatology. 2010;52(1):79–104. https://doi.org/10.1002/hep.23623.

    Article  CAS  PubMed  Google Scholar 

  65. Gitto S, Vitale G, Villa E, Andreone P. Treatment of nonalcoholic steatohepatitis in adults: present and future. Gastroenterol Res Pract. 2015;2015:732870. https://doi.org/10.1155/2015/732870.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM, et al. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med. 2010;362(18):1675–85. https://doi.org/10.1056/NEJMoa0907929.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Klein EA, Thompson IM Jr, Tangen CM, Crowley JJ, Lucia MS, Goodman PJ, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2011;306(14):1549–56. https://doi.org/10.1001/jama.2011.1437.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Schurks M, Glynn RJ, Rist PM, Tzourio C, Kurth T. Effects of vitamin E on stroke subtypes: meta-analysis of randomised controlled trials. BMJ. 2010;341:c5702. https://doi.org/10.1136/bmj.c5702.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Boettcher E, Csako G, Pucino F, Wesley R, Loomba R. Meta-analysis: pioglitazone improves liver histology and fibrosis in patients with non-alcoholic steatohepatitis. Aliment Pharmacol Ther. 2012;35(1):66–75. https://doi.org/10.1111/j.1365-2036.2011.04912.x.

    Article  CAS  PubMed  Google Scholar 

  70. Wree A, Broderick L, Canbay A, Hoffman HM, Feldstein AE. From NAFLD to NASH to cirrhosis-new insights into disease mechanisms. Nat Rev Gastroenterol Hepatol. 2013;10(11):627–36. https://doi.org/10.1038/nrgastro.2013.149.

    Article  CAS  PubMed  Google Scholar 

  71. Li B, Zhang C, Zhan YT. Nonalcoholic fatty liver disease cirrhosis: a review of its epidemiology, risk factors, clinical presentation, diagnosis, management, and prognosis. Can J Gastroenterol Hepatol. 2018;2018:2784537. https://doi.org/10.1155/2018/2784537.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Athyros VG, Mikhailidis DP, Didangelos TP, Giouleme OI, Liberopoulos EN, Karagiannis A, et al. Effect of multifactorial treatment on non-alcoholic fatty liver disease in metabolic syndrome: a randomised study. Curr Med Res Opin. 2006;22(5):873–83. https://doi.org/10.1185/030079906X104696.

    Article  CAS  PubMed  Google Scholar 

  73. Carbone LJ, Angus PW, Yeomans ND. Incretin-based therapies for the treatment of non-alcoholic fatty liver disease: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2016;31(1):23–31. https://doi.org/10.1111/jgh.13026.

    Article  CAS  PubMed  Google Scholar 

  74. Germani G, Laryea M, Rubbia-Brandt L, Egawa H, Burra P, O’Grady J, et al. Management of recurrent and de novo NAFLD/NASH after liver transplantation. Transplantation. 2019;103(1):57–67. https://doi.org/10.1097/TP.0000000000002485.

    Article  PubMed  Google Scholar 

  75. Gitto S, Villa E. Non-alcoholic fatty liver disease and metabolic syndrome after liver transplant. Int J Mol Sci. 2016;17(4):490. https://doi.org/10.3390/ijms17040490.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Kueht M, Thompson P, Rana A, Cotton R, O’Mahony C, Goss J. Effects of an early referral system on liver transplantation for hepatoblastoma at Texas Children’s Hospital. Pediatr Transplant. 2016;20(4):515–22. https://doi.org/10.1111/petr.12699.

    Article  PubMed  Google Scholar 

  77. Lim LG, Cheng CL, Wee A, Lim SG, Lee YM, Sutedja DS, et al. Prevalence and clinical associations of posttransplant fatty liver disease. Liver Int. 2007;27(1):76–80. https://doi.org/10.1111/j.1478-3231.2006.01396.x.

    Article  PubMed  Google Scholar 

  78. Malik SM, Devera ME, Fontes P, Shaikh O, Sasatomi E, Ahmad J. Recurrent disease following liver transplantation for nonalcoholic steatohepatitis cirrhosis. Liver Transpl. 2009;15(12):1843–51. https://doi.org/10.1002/lt.21943.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Karen Krok.

Ethics declarations

Conflict of Interest

Niranjani Venkateswaran, Scott Weismiller, and Karen Krok declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Fatty Liver Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Venkateswaran, N., Weismiller, S. & Krok, K. Recurrent NASH Post-liver Transplant: Implications and Treatment. Curr Hepatology Rep 20, 108–116 (2021). https://doi.org/10.1007/s11901-021-00569-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11901-021-00569-7

Keywords

Navigation