Fat and liver transplantation: clinical implications

Area of Science:

• Hepatology
• Transplantation Medicine
• Metabolic Disorders

Background:

• Nonalcoholic steatohepatitis (NASH) is an increasing cause for liver transplantation (LT) globally.
• NASH patients often present with metabolic syndrome and cardiovascular issues, complicating LT evaluation and management.
• Post-LT survival in NASH recipients is favorable, comparable to other indications, especially without cardiovascular comorbidities.

Purpose of the Study:

• To review the evaluation and management of NASH patients undergoing LT.
• To analyze the natural history of NASH pre- and post-LT, including disease recurrence.
• To discuss the use of steatotic liver grafts and strategies for improving outcomes.

Main Methods:

• Review of current literature on NASH and liver transplantation.
• Analysis of patient evaluation, surgical considerations, and post-LT outcomes.
• Discussion of graft utilization, particularly steatotic livers, and optimization strategies.

Main Results:

• Post-LT survival for NASH patients is excellent, particularly when cardiovascular comorbidities are absent.
• NASH recurrence in the allograft is common, but progression to advanced disease is infrequent in the short term.
• The use of steatotic donor grafts is increasing due to organ shortages.

Conclusions:

• NASH is a significant and growing indication for LT with good long-term survival.
• Careful management of comorbidities and understanding graft limitations are crucial for successful LT in NASH patients.
• Further research is needed on long-term recurrence and optimizing outcomes with steatotic grafts.