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

Canbay, Ali; Sowa, Jan-Peter; Syn, Wing–Kin; Treckmann, Jürgen

doi:10.1159/000446379

Cited by 25 publications

(19 citation statements)

References 36 publications

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“…However, almost one-third of patients who receive liver transplant for NASH will have recurrence of the disease in the transplanted liver in the absence of intense post-transplant lifestyle modifications. 105 , 106 …”

Section: Liver Transplantationmentioning

confidence: 99%

Non-alcoholic Fatty Liver Disease: A Clinical Update

Pappachan

Babu

Krishnan

et al. 2017

Journal of Clinical and Translational Hepatology

111

119

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Non-alcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease in developed countries because of the obesity epidemic. The disease increases liver-related morbidity and mortality, and often increases the risk for other comorbidities, such as type 2 diabetes and cardiovascular disease. Insulin resistance related to metabolic syndrome is the main pathogenic trigger that, in association with adverse genetic, humoral, hormonal and lifestyle factors, precipitates development of NAFLD. Biochemical markers and radiological imaging, along with liver biopsy in selected cases, help in diagnosis and prognostication. Intense lifestyle changes aiming at weight loss are the main therapeutic intervention to manage cases. Insulin sensitizers, antioxidants, lipid lowering agents, incretin-based drugs, weight loss medications, bariatric surgery and liver transplantation may be necessary for management in some cases along with lifestyle measures. This review summarizes the latest evidence on the epidemiology, natural history, pathogenesis, diagnosis and management of NAFLD.

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Section: Liver Transplantationmentioning

confidence: 99%

Non-alcoholic Fatty Liver Disease: A Clinical Update

Pappachan

Babu

Krishnan

et al. 2017

Journal of Clinical and Translational Hepatology

111

119

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“…NASH can cause some serious complications, such as liver failure [1], cirrhosis [2,3] and hepatocellular carcinoma [4]. Furthermore, NASH risk is increasing worldwide [5,6,7].…”

Section: Introductionmentioning

confidence: 99%

The Combination of Blueberry Juice and Probiotics Ameliorate Non-Alcoholic Steatohepatitis (NASH) by Affecting SREBP-1c/PNPLA-3 Pathway via PPAR-α

Ren

Zhu

et al. 2017

Nutrients

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Nonalcoholic steatohepatitis (NASH) is liver inflammation and a major threat to public health. Several pharmaceutical agents have been used for NASH therapy but their high-rate side effects limit the use. Blueberry juice and probiotics (BP) have anti-inflammation and antibacterial properties, and may be potential candidates for NASH therapy. To understand the molecular mechanism, Sprague Dawley rats were used to create NASH models and received different treatments. Liver tissues were examined using HE (hematoxylin and eosin) and ORO (Oil Red O) stain, and serum biochemical indices were measured. The levels of peroxisome proliferators-activated receptor (PPAR)-α, sterol regulatory element binding protein-1c (SREBP-1c), Patatin-like phospholipase domain-containing protein 3 (PNPLA-3), inflammatory cytokines and apoptosis biomarkers in liver tissues were measured by qRT-PCR and Western blot. HE and ORO analysis indicated that the hepatocytes were seriously damaged with more and larger lipid droplets in NASH models while BP reduced the number and size of lipid droplets (p < 0.05). Meanwhile, BP increased the levels of SOD (superoxide dismutase), GSH (reduced glutathione) and HDL-C (high-density lipoprotein cholesterol), and reduced the levels of AST (aspartate aminotransferase), ALT (alanine aminotransferase), TG (triglycerides), LDL-C (low-density lipoprotein cholesterol) and MDA (malondialdehyde) in NASH models (p < 0.05). BP increased the level of PPAR-α (Peroxisome proliferator-activated receptor α), and reduced the levels of SREBP-1c (sterol regulatory element binding protein-1c) and PNPLA-3 (Patatin-like phospholipase domain-containing protein 3) (p < 0.05). BP reduced hepatic inflammation and apoptosis by affecting IL-6 (interleukin 6), TNF-α (Tumor necrosis factor α), caspase-3 and Bcl-2 in NASH models. Furthermore, PPAR-α inhibitor increased the level of SREBP-1c and PNPLA-3. Therefore, BP prevents NASH progression by affecting SREBP-1c/PNPLA-3 pathway via PPAR-α.

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“…It is estimated that approximately one-third of the current population in industrialized countries has NAFLD as a consequence of the liver’s involvement in the context of MetS. As mentioned above and according to many authors, it is clear that over the next ten or twenty years, the prevalence of NAFLD will increase due to the epidemic rise in obesity, T2DM, arterial hypertension and the prevalence of MetS, as well as people living longer[ 10 - 13 ]. Consequently, NAFLD-related liver disease is currently the most rapidly increasing indication for LT in the US, and it is anticipated that NAFLD-related liver disease will become the leading indication for LT in the near future[ 14 , 15 ].…”

Section: Nafld Related End-stage Liver Disease and Hcc As Indicationsmentioning

confidence: 99%

“…Similarly, a recently published US study found that HCC as a consequence of NASH is the fastest growing indication for LT. The authors of this study reported that NASH related HCC as an indication for LT had an almost fourfold increase since 2002; on the other hand, HCC that results from HCV, doubled[ 13 , 21 ].…”

Section: Nafld Related End-stage Liver Disease and Hcc As Indicationsmentioning

confidence: 99%

Nonalcoholic fatty liver disease and liver transplantation - Where do we stand?

Mikolašević¹,

Filipec-Kanižaj²,

Mijić³

et al. 2018

WJG

108

100

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Nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) is a challenging and multisystem disease that has a high socioeconomic impact. NAFLD/NASH is a main cause of macrovesicular steatosis and has multiple impacts on liver transplantation (LT), on patients on the waiting list for transplant, on post-transplant setting as well as on organ donors. Current data indicate new trends in the area of chronic liver disease. Due to the increased incidence of metabolic syndrome (MetS) and its components, NASH cirrhosis and hepatocellular carcinoma caused by NASH will soon become a major indication for LT. Furthermore, due to an increasing incidence of MetS and, consequently, NAFLD, there will be more steatotic donor livers and less high quality organs available for LT, in addition to a lack of available liver allografts. Patients who have NASH and are candidates for LT have multiple comorbidities and are unique LT candidates. Finally, we discuss long-term grafts and patient survival after LT, the recurrence of NASH and NASH appearing de novo after transplantation. In addition, we suggest topics and areas that require more research for improving the health care of this increasing patient population.

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

Cited by 25 publications

References 36 publications

Non-alcoholic Fatty Liver Disease: A Clinical Update

Non-alcoholic Fatty Liver Disease: A Clinical Update

The Combination of Blueberry Juice and Probiotics Ameliorate Non-Alcoholic Steatohepatitis (NASH) by Affecting SREBP-1c/PNPLA-3 Pathway via PPAR-α

Nonalcoholic fatty liver disease and liver transplantation - Where do we stand?

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