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Digestive Diseases and Sciences

, Volume 64, Issue 12, pp 3413–3430 | Cite as

Liver Transplantation for Nonalcoholic Steatohepatitis: Pathophysiology of Recurrence and Clinical Challenges

  • Naga Swetha Samji
  • Rajanshu Verma
  • Krishna Chaitanya Keri
  • Ashwani K. Singal
  • Aijaz Ahmed
  • Mary Rinella
  • David Bernstein
  • Manal F. Abdelmalek
  • Sanjaya K. SatapathyEmail author
Review

Abstract

Nonalcoholic steatohepatitis is the fastest-growing indication for the liver transplant and a leading cause of hepatocellular carcinoma among patients listed for liver transplantation in the USA. Post-transplant nonalcoholic hepatic steatosis and steatohepatitis are frequent complications of liver transplantation. Nonalcoholic steatohepatitis poses a significant challenge in both pre- and post-transplant period due to its association with metabolic syndrome, coronary artery disease, chronic kidney disease, and obstructive sleep apnea. While optimal therapy is not yet available in the post-liver transplant setting, lifestyle interventions continue to remain as the mainstay of therapy for post-transplant nonalcoholic steatohepatitis. Early recognition with protocol biopsies and noninvasive modalities, along with modification of known risk factors, are the most effective methods to curtail the progression of nonalcoholic steatohepatitis in the absence of FDA-approved pharmacologic therapy.

Keywords

Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Liver transplantation Cryptogenic cirrhosis Immunosuppression Obesity-related liver disease Metabolic syndrome 

Notes

Author’s Contribution

SKS conceptualized the manuscript. Initial draft was prepared by NSS with help from RV who prepared the tables and figures. All other authors participated in the critical revision of the manuscript for important intellectual content.

Compliance with Ethical Standards

Conflict of interest

Dr. Abdelmalek reports no conflicts of interest related to the submitted work. Dr. Abdelmalek reports receiving grants awarded to her institution from NIH/NIDDK, Gilead, Conatus, Intercept, NGM, BMS, Boeringher-Ingelheim, Madrigal, Inventiva, Enanta, Novartis, Allergan, Target-NASH, Progenity, TaiwanJ, Poxel, Novo Nordisk, and Celgene. She participated in Speakers Bureau for Alexion, Simply Speaking NASH, MedScape, iHep NASH, and Clinical Care Options and is on the Scientific Advisory Board for NGM, BMS, TaiwanJ, Pfizer, Madrigal, Prometic, and SanoNASH. Dr. Sanjaya Satapathy reports no conflicts of interest related to the submitted work. Dr. Satapathy reports receiving grants from Gilead Sciences and participated in Speakers Bureau, Advisory Board of Gilead Sciences, received grants from Intercept Pharmaceuticals and participated in the Speakers Bureau, Advisory Board of Intercept Pharmaceuticals, received grants from Shire, grants from Conatus, grants from Bayer, and participated in the Speakers Bureau of Alexion, received grants from Dova and participated in the Speakers Bureau, and Advisory Board of Dova, received grants from Genfit, grants from Exact Sciences, and participated in the Advisory Board of Abbvie, outside the submitted work. Dr. Aijaz Ahmed, Dr. Samji Swetha, Dr. Ashwani Singal, Dr. Krishna Chaitanya Keri, Dr. Rajanshu Verma, and Dr. Manal Abdelmalek report no conflicts of interest related to the submitted work. Dr. David Bernstein reports no conflicts of interest related to the submitted work. He reports consulting/Ad Boards for Abbvie, Gilead, Dova, Shinoigi, Mallinkropt, Intercept, and reports having received research support from Abbvie, Gilead, Dova, Conatus, CymBay, Merck, BI, NovoNordisk, Novartis. Dr. Rinella reports no conflicts of interested related to this manuscript. She does consulting for the following pharmaceutical companies: Intercept, Gilead, NGM, BMS, Enanta, Novartis, Genfit, Immuron, Cymabay, Merck, Gelesis, Metacrine, Viking, Madrigal, Allergan, Thetis, Fractyl, 3vBio. She has received independent research funding from Novartis. She has no stock ownership in any company for whom she consults and is on no speakers bureaus.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Naga Swetha Samji
    • 1
  • Rajanshu Verma
    • 2
  • Krishna Chaitanya Keri
    • 3
  • Ashwani K. Singal
    • 4
  • Aijaz Ahmed
    • 5
  • Mary Rinella
    • 6
  • David Bernstein
    • 7
  • Manal F. Abdelmalek
    • 8
  • Sanjaya K. Satapathy
    • 9
    Email author
  1. 1.Tennova Cleveland HospitalClevelandUSA
  2. 2.Division of Transplant Surgery, Department of SurgeryMethodist University Hospital Transplant Institute, University of Tennessee Health Sciences CenterMemphisUSA
  3. 3.Tenessee Kidney CareOoltewahUSA
  4. 4.University of South Dakota Sanford School of MedicineAvera Transplant InstituteSioux FallsUSA
  5. 5.Division of Gastroenterology and HepatologyStanford University School of MedicineStanfordUSA
  6. 6.Department of MedicineNorthwestern University, Feinberg School of MedicineChicagoUSA
  7. 7.Division of Hepatology and Sandra Atlas Bass Center for Liver DiseasesNorthwell HealthManhassetUSA
  8. 8.Division of Gastroenterology/HepatologyDuke UniversityDurhamUSA
  9. 9.Division of Hepatology at Sandra Atlas Bass Center for Liver Diseases and TransplantationDonald and Barbara Zucker School of Medicine at Hofstra/Northwell HealthManhassetUSA

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