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

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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.

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Authors and Affiliations

  1. Tennova Cleveland Hospital, 2305 Chambliss Ave NW, Cleveland, TN, 37311, USA

    Naga Swetha Samji

  2. Division of Transplant Surgery, Department of Surgery, Methodist University Hospital Transplant Institute, University of Tennessee Health Sciences Center, Memphis, TN, USA

    Rajanshu Verma

  3. Tenessee Kidney Care, 5243, Little Debbie Pkwy, Ste 119, Ooltewah, TN, USA

    Krishna Chaitanya Keri

  4. University of South Dakota Sanford School of Medicine, Avera Transplant Institute, S. Cliff Ave, Sioux Falls, SD, 57105, USA

    Ashwani K. Singal

  5. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA

    Aijaz Ahmed

  6. Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA

    Mary Rinella

  7. Division of Hepatology and Sandra Atlas Bass Center for Liver Diseases, Northwell Health, Manhasset, NY, USA

    David Bernstein

  8. Division of Gastroenterology/Hepatology, Duke University, 40 Duke Medicine Cir, Durham, NC, USA

    Manal F. Abdelmalek

  9. Division of Hepatology at Sandra Atlas Bass Center for Liver Diseases and Transplantation, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 400 Community Drive, Manhasset, NY, 11030, USA

    Sanjaya K. Satapathy

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  1. Naga Swetha Samji
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Contributions

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.

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Correspondence to Sanjaya K. Satapathy.

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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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Samji, N.S., Verma, R., Keri, K.C. et al. Liver Transplantation for Nonalcoholic Steatohepatitis: Pathophysiology of Recurrence and Clinical Challenges. Dig Dis Sci 64, 3413–3430 (2019). https://doi.org/10.1007/s10620-019-05716-1

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