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Liver Transplantation for NASH-Related Cirrhosis

  • Solid Organ Transplantation (C Sonnenday, Section Editor)
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Abstract

Nonalcoholic steatohepatitis (NASH) is on a trajectory to become the leading indication for liver transplantation. It is an important risk factor for hepatocellular carcinoma and chronic kidney disease and, as such, is poised to have a major impact on the liver transplant community in the coming decades. While the optimal approach to the patient with NASH-related cirrhosis is evolving, careful attention to the cardiovascular, metabolic, renal, and obesity risk factors represents the mainstay of treatment. Management of these factors also offer the greatest opportunity for improvement of long-term outcomes in these patients.

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References

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

  1. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55(6):2005–23 Epub 2012/04/11.

    Article  PubMed  Google Scholar 

  2. Zezos P, Renner EL. Liver transplantation and non-alcoholic fatty liver disease. World J. Gastroenterol. 2014;20(42):15532–8 Epub 2014/11/18.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Rafiq N, Bai C, Fang Y, Srishord M, McCullough A, Gramlich T, et al. Long-term follow-up of patients with nonalcoholic fatty liver. Clin. Gastroenterol. Hepatol. 2009;7(2):234–8 Epub 2008/12/04.

    Article  PubMed  Google Scholar 

  4. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34(3):274–85 Epub 2011/06/01.

    Article  CAS  PubMed  Google Scholar 

  5. Koehler E, Watt K, Charlton M. Fatty liver and liver transplantation. Clin Liver Dis. 2009;13(4):621–30 Epub 2009/10/13.

    Article  PubMed  Google Scholar 

  6. Williams CD, Stengel J, Asike MI, Torres DM, Shaw J, Contreras M, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011;140(1):124–31 Epub 2010/09/23.

    Article  PubMed  Google Scholar 

  7. • Afzali A, Berry K, Ioannou GN. Excellent posttransplant survival for patients with nonalcoholic steatohepatitis in the United States. Liver Transplant. 2012;18(1):29–37. This is 1 of 2 studies that describe the frequency of NASH as an indication for liver transplantation and reports on the outcoms of a large cohort.

  8. • Charlton MR, Burns JM, Pedersen RA, Watt KD, Heimbach JK, Dierkhising RA. Frequency and outcomes of liver transplantation for nonalcoholic steatohepatitis in the United States. Gastroenterology. 2011;141(4):1249–53. This is 1 of 2 studies that describe the frequency of NASH as an indication for liver transplantation and reports on the outcoms of a large cohort.

  9. Conzen KD, Vachharajani N, Collins KM, Anderson CD, Lin Y, Wellen JR, et al. Morbid obesity in liver transplant recipients adversely affects longterm graft and patient survival in a single-institution analysis. HPB. 2015;17(3):251–7 Epub 2014/10/18.

    Article  PubMed  Google Scholar 

  10. Stine JG, Shah NL, Argo CK, Pelletier SJ, Caldwell SH, Northup PG. Increased risk of portal vein thrombosis in patients with cirrhosis due to non-alcoholic steatohepatitis (NASH). Liver Transplant. 2015. Epub 2015/04/08.

  11. 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. 2012;14(9):625–34 Epub 2012/08/14.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Hoehn RS, Singhal A, Wima K, Sutton JM, Paterno F, Steve Woodle E, et al. Effect of pretransplant diabetes on short-term outcomes after liver transplantation: a national cohort study. Liver Int. 2014. Epub 2014/12/24.

  13. Wang X, Li J, Riaz DR, Shi G, Liu C, Dai Y. Outcomes of liver transplantation for nonalcoholic steatohepatitis: a systematic review and meta-analysis. Clin. Gastroenterol. Hepatol. 2014;12(3):394–402 Epub 2013/10/01.

    Article  PubMed  Google Scholar 

  14. Bell LN, Lee L, Saxena R, Bemis KG, Wang M, Theodorakis JL, et al. Serum proteomic analysis of diet-induced steatohepatitis and metabolic syndrome in the Ossabaw miniature swine. Am J Physiol Gastrointest Liver Physiol. 2010;298(5):G746–54 Epub 2010/02/20.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Adams LA, Lymp JF, St Sauver J, Sanderson SO, Lindor KD, Feldstein A, et al. The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology. 2005;129(1):113–21 Epub 2005/07/14.

    Article  PubMed  Google Scholar 

  16. White DL, Kanwal F, El-Serag HB. Association between nonalcoholic fatty liver disease and risk for hepatocellular cancer, based on systematic review. Clin. Gastroenterol. Hepatol. 2012;10(12):1342–59 Epub 2012/10/09.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Ascha MS, Hanouneh IA, Lopez R, Tamimi TA, Feldstein AF, Zein NN. The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis. Hepatology. 2010;51(6):1972–8 Epub 2010/03/09.

    Article  PubMed  Google Scholar 

  18. Wong RJ, Cheung R, Ahmed A. Nonalcoholic steatohepatitis is the most rapidly growing indication for liver transplantation in patients with hepatocellular carcinoma in the U.S. Hepatology. 2014;59(6):2188–95 Epub 2014/01/01.

    Article  PubMed  Google Scholar 

  19. Fussner LA, Charlton MR, Heimbach JK, Fan C, Dierkhising R, Coss E, et al. The impact of gender and NASH on chronic kidney disease before and after liver transplantation. Liver Int. 2014;34(8):1259–66 Epub 2013/11/23.

    Article  CAS  PubMed  Google Scholar 

  20. • Musso G, Gambino R, Tabibian JH, Ekstedt M, Kechagias S, Hamaguchi M, et al. Association of non-alcoholic fatty liver disease with chronic kidney disease: a systematic review and meta-analysis. PLoS Med. 2014;11(7):e1001680. Reports on the risk of CKD in patients with NASH.

  21. • Houlihan DD, Armstrong MJ, Davidov Y, Hodson J, Nightingale P, Rowe IA, et al. Renal function in patients undergoing transplantation for nonalcoholic steatohepatitis cirrhosis: time to reconsider immunosuppression regimens? Liver Transplant. 2011;17(11):1292–8. This study reports on the risk and effect of CKD on patients with NASH related cirrhosis undergoing liver transplant.

  22. Singal AK, Salameh H, Kuo YF, Wiesner RH. Evolving frequency and outcomes of simultaneous liver kidney transplants based on liver disease etiology. Transplantation. 2014;98(2):216–21 Epub 2014/03/14.

    Article  CAS  PubMed  Google Scholar 

  23. Maor-Kendler Y, Batts KP, Burgart LJ, Wiesner RH, Krom RA, Rosen CB, et al. Comparative allograft histology after liver transplantation for cryptogenic cirrhosis, alcohol, hepatitis C, and cholestatic liver diseases. Transplantation. 2000;70(2):292–7 Epub 2000/08/10.

    Article  CAS  PubMed  Google Scholar 

  24. El Atrache MM, Abouljoud MS, Divine G, Yoshida A, Kim DY, Kazimi MM, et al. Recurrence of non-alcoholic steatohepatitis and cryptogenic cirrhosis following orthotopic liver transplantation in the context of the metabolic syndrome. Clin Transplant. 2012;26(5):E505–12 Epub 2012/10/16.

    Article  PubMed  Google Scholar 

  25. Trudeau RE, Bowman LJ, Wills AR, Crippin JS, Chapman WC, Anderson C. Once weekly fluconazole for antifungal prophylaxis post-liver transplantation. HPB. 2013;15(7):541–7 Epub 2013/03/06.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Watt KD, Charlton MR. Metabolic syndrome and liver transplantation: a review and guide to management. J Hepatol. 2010;53(1):199–206 Epub 2010/05/11.

    Article  PubMed  Google Scholar 

  27. Haddad EM, McAlister VC, Renouf E, Malthaner R, Kjaer MS, Gluud LL. Cyclosporin versus tacrolimus for liver transplanted patients. Cochrane Database Syst. Rev. 2006;4:CD005161 Epub 2006/10/21.

    PubMed  Google Scholar 

  28. • Heimbach JK, Watt KD, Poterucha JJ, Ziller NF, Cecco SD, Charlton MR, et al. Combined liver transplantation and gastric sleeve resection for patients with medically complicated obesity and end-stage liver disease. Am J Transpl. 2013;13(2):363–8. Reports the preliminary safety and efficacy of sleeve gastrectomy in combination with liver transplant.

  29. Lazzati A, Iannelli A, Schneck AS, Nelson AC, Katsahian S, Gugenheim J, et al. Bariatric surgery and liver transplantation: a systematic review a new frontier for bariatric surgery. Obes Surg. 2015;25(1):134–42 Epub 2014/10/23.

    Article  PubMed  Google Scholar 

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Correspondence to Christopher D. Anderson.

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This article is part of the Topical Collection on Solid Organ Transplantation.

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Anderson, C.D. Liver Transplantation for NASH-Related Cirrhosis. Curr Surg Rep 3, 24 (2015). https://doi.org/10.1007/s40137-015-0101-6

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  • DOI: https://doi.org/10.1007/s40137-015-0101-6

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