Evaluation of liver transplant candidates with non-alcoholic steatohepatitis

Abstract

Non-alcoholic fatty liver disease (NAFLD) and liver transplantation (LT) NAFLD affects 75 to 100 million Americans and up to 25% of the global population (1,2). The prevalence of NAFLD is expected to increase by 60% in the next decade, in parallel with the obesity epidemic, making NAFLD the most common chronic liver disease (3,4). Non-alcoholic steatohepatitis (NASH), affecting 10-30% of patients with NAFLD, is the progressive form of NAFLD that leads to cirrhosis and is associated with cardiovascular (CV) and liver-related morbidity and mortality (5). Hepatic fibrosis is the most important predictor of mortality in NASH (6).One in four NASH patients will progress to cirrhosis over 8 years on average (7). Patients with NASH-related cirrhosis are at increased risk of hepatocellular carcinoma (HCC), occurring at an annual incidence of 0.3-4.3% (8).NASH is currently the 2 nd most common indication for LT in the U.S., but is the fastest growing indication for LT and simultaneous liver-kidney (SLK) transplants and the fastest growing cause of HCC in LT recipients (9-13). NASH is expected to overtake chronic hepatitis C as the most common indication for LT. In the last two decades, waitlist registrations, liver transplants, and SLK transplants for NASH increased 3-fold each (9-11), while the number of LT registrants and recipients with HCC attributable to

Successful Treatment of Achalasia With Endoscopic Ultrasound–Guided Botulinum Injection in Setting of Esophageal Varices

“…5 Patients with concomitant sarcopenia and liver cirrhosis experience greater prevalence of hepatic decompensation, hepatocellular carcinoma, and infections, which could delay or prevent liver transplantation. 6 In most cases, malnutrition in a patient with liver cirrhosis is either ascribed to the underlying disease process of cirrhosis, gastroesophageal reflux disease, and esophageal variceal ligation resulting in secondary dysmotility, scleroderma, or cyclosporine-based immunosuppression. 7 However, additional motility disorders such as achalasia can complicate the clinical picture and exacerbate underlying malnutrition.…”

Non-alcoholic fatty liver disease-related hepatocellular carcinoma

“… 49 Among patients with NAFLD, assessment and optimization of associated comorbidities including obesity, metabolic syndrome, and cardiovascular disease is particularly important, both while waiting for liver transplantation and afterwards. 99 Despite a higher prevalence of these comorbidities, data from the European Liver Transplant Registry showed no difference in survival between NAFLD and non-NAFLD patients. 100 An analysis of the UNOS registry in the United States suggests patients with NAFLD may even have higher post-transplant survival (HR, 0.69; 95% CI, 0.63-0.77), potentially related to more rigorous patient selection.…”

The Impact and Burden of Dietary Sugars on the Liver

“… 16 Recent data suggest that NAFLD will become the most common indication for liver transplantation in the near future. 17 NAFLD accounts for the highest increase in disability-adjusted life years compared to other liver-related chronic diseases. 18 At the individual level, the cost of medical care (due to testing, monitoring, and hospitalization) for a patient with NAFLD is estimated to be nearly twice as high compared with healthy individuals.…”