NAFLD and liver transplantation: Disease burden, current management and future challenges.

Burra, Patrizia; Becchetti, Chiara; Germani, Giacomo (2020). NAFLD and liver transplantation: Disease burden, current management and future challenges. JHEP reports, 2(6), p. 100192. Elsevier 10.1016/j.jhepr.2020.100192

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Non-alcoholic fatty liver disease (NAFLD), specifically its progressive form non-alcoholic steatohepatitis (NASH), represents the fastest growing indication for liver transplantation in Western countries. Diabetes mellitus, morbid obesity and cardiovascular disease are frequently present in patients with NAFLD who are candidates for liver transplantation. These factors require specific evaluation, including a detailed pre-surgical risk stratification, in order to improve outcomes after liver transplantation. Moreover, in the post-transplantation setting, the incidence of cardiovascular events and metabolic complications can be amplified by immunosuppressive therapy, which is a well-known driver of metabolic alterations. Indeed, patients with NASH are more prone to developing early post-transplant complications and, in the long-term, de novo malignancy and cardiovascular events, corresponding to higher mortality rates. Therefore, a tailored multidisciplinary approach is required for these patients, both before and after liver transplantation. Appropriate candidate selection, lifestyle modifications and specific assessment in the pre-transplant setting, as well as pharmacological strategies, adjustment of immunosuppression and a healthy lifestyle in the post-transplant setting, play a key role in correct management.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine

UniBE Contributor:

Becchetti, Chiara

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2589-5559

Publisher:

Elsevier

Language:

English

Submitter:

Rahel Fuhrer

Date Deposited:

01 Dec 2020 17:33

Last Modified:

13 Mar 2021 12:18

Publisher DOI:

10.1016/j.jhepr.2020.100192

PubMed ID:

33163950

Uncontrolled Keywords:

CKD, chronic kidney disease CNI, calcineurin inhibitors DM, diabetes mellitus DPP-4, dipeptidyl peptidase-4 ELTR, European Liver Transplant Registry ESLD, end-stage liver disease GLP1 RAs, glucagon-like peptide-1 receptor agonists Graft survival HCC, hepatocellular carcinoma HR, hazard ratio Hypertension IRR, incidence rate ratio Immunosuppressant LT, liver transplant MAFLD, metabolic dysfunction-associated fatty liver disease Metabolic complication NAFLD, non-alcoholic fatty liver disease NASH, non-alcoholic steatohepatitis New-onset diabetes after transplantation Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis OR, odds ratio Obesity Patient survival SGLT2, sodium-glucose co-transporter-2 Solid organ transplantation UNOS, United Network for Organ Sharing mTORi, mammalian target of rapamycin inhibitors

BORIS DOI:

10.7892/boris.148436

URI:

https://boris.unibe.ch/id/eprint/148436

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