NASH Cirrhosis - the New Burden in Liver Transplantation: How Should It Be Managed?

BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a continuously increasing cause of chronic liver disease and a health burden in all populations affected by the obesity and metabolic syndrome pandemic. Cirrhotic alterations or hepatocellular carcinoma developing from NAFLD may require liver transplantation (LTx). METHODS Current literature was screened for data on LTx in the setting of NAFLD. RESULTS NAFLD-associated LTx is expected to increase in number and relevance during the next decade. NAFLD is part of the metabolic syndrome and thus connected to various metabolic alterations and comorbidities such as diabetes or hyperlipidemia. Moreover, NAFLD comprises an independent risk factor for cardiovascular and chronic kidney disease, which again are important risk factors for outcome of surgical interventions. Postoperative immunosuppression, possible steatosis of the liver graft, and a continued presence of metabolic alterations may lead to early recurrence of steatosis or even non-alcoholic steatohepatitis. Currently, no data are available on combined approaches of weight loss and LTx for NAFLD. CONCLUSION Specific guidelines on how to manage NAFLD-associated LTx are lacking. This particular situation requires close monitoring of metabolic syndrome-associated comorbidities. NAFLD represents a novel challenge to established LTx procedures.